Name:
Address:
Phone Number:
Email Address:
Student 1:
Student 2:
I would like to register for the following length lessons starting fall, 2015: 30-minute lessons ($168/month, $489/quarter) 45-minute lessons ($234/month, $680/quarter) 60-minute lessons ($300/month, $872/quarter)
I would like to pay: Monthly Quarterly
My preferred lesson day and time is:
In case that cannot be accommodated, I am available the following days for lessons:
On those days, my restrictions are as follows:
I give permission to include my child's lesson time as well as my aforementioned phone number and e-mail address on the fall swap list in order to trade with another student in the need should arise.
I will bring the Fall Deposit of $100 to my next lesson.