Contact

student registration form

Name (please register each student separately) *

First

Last

Registration is for: *

Fall Term, Aug. 22nd to Dec. 18th, 2017 Spring Term, January to May, 2018

Choose One *

Continuing student Transfer Student New Student

Best Phone Number (leave blank if continuing student) *

What type of phone line is it? *

Alternate Phone Number *

What type of phone line is it? *

Email address *

Parent name(s) if applicable *

Address (leave blank if continuing student) *

Line 1

Line 2

City

State

Zip Code

Country

Lesson Length (for individual piano lessons) *

Please list all times you are available for piano lessons M-Th, 3-8pm. You may enter preferred times as well. *

How did you hear about Adam Revell? *

Comments or questions *

By registering for piano lessons on a weekly basis, I understand that being present at every scheduled lesson is a requirement. I understand that I am paying for a weekly time slot, and that slot is exclusively mine unless we agree on changing to a different time. I understand that there are no refunds for missed lessons, but that instead, makeup lessons will be scheduled up to once per month. Lessons cancelled less than 24 hours in advance due to sickness or family emergency will be rescheduled to a makeup day. Lessons canceled less than 24 hours in advance for other reasons will not be refunded or rescheduled.

By filling out and submitting this form, I understand that I am registering for piano lessons, and I have read and understand the piano lessons policies, found on the "Piano Lessons" page. *

I agree, and wish to register I am contacting you about something else (please indicate in the "comments or questions'" field)