* Required

Student's first name*required

Student's last name*required

Academic grade of student*required

Prefix

Parent's first name*required

Parent's last name*required

Parent's email address*required

Primary contact phone number*required

Ext

Secondary contact phone number

Ext

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Select an instrument*

Private violin lessons  Private piano lessons 

Indicate level of experience with this instrument:*

Beginner  Past experience with this instrument 

To begin piano lessons you must have access to a piano or full-size keyboard. Please indicate your child's access to a piano. *

I currently have a piano/full-size at home  I do not yet have a piano/full-size keyboard at home, but agree to get one by the start of the lessons 

I understand and agree that my child will automatically be re-enrolled for the subsequent semester/ year unless I notify the piano & violin department that I wish to discontinue lessons. Notification is required by the first day of the new semester.*

I agree 

Piano and violin fees are billed through Smart Tuition and added to the overall tuition amount. These fees are non-refundable once the semester has begun.

Electronic signature of Parent (Please type name)*required

Date *required

Please send a confirmation email to the address below: