Private Lesson Interest Form Use the form below to sign up for private lessons. Lessons Signup Form - Interest Only Student's Name * First * Last Current Age of Student * Email * Preferred Lesson Type * Private Piano Lessons (1 on 1) Private Guitar/Ukulele Lessons (1 on 1) Private Voice Lessons (1 on 1) Parent/Guardian First Name * Parent/Guardian Last Name * Cell Phone Number * I have read and I agree with the studio policies and procedures and agree to abide by them. ***NOTICE*** They have been updated for the fall semester * Yes Click here to read our Studio Policies and Procedures From time to time the studio/teacher will photograph and post images or video of lessons or events to be used on Facebook, LaGrangePianoLesssons.com, and/or other social media outlets. We respect the student’s and parent’s right to privacy and would like to have permission to use images of the student online. * Yes, I agree to allow the use of my child's image No, I do not allow the use of my child's image I understand that if I choose to pay monthly I will be required to keep a credit card on file and will be automatically charged at the beginning of each month. I understand that failure to keep an active credit card on file will cause all lessons to be paused until a valid credit card is on file. * I understand that if I choose to pay monthly I will be required to keep a credit card on file and will be automatically charged at the beginning of each month. I understand that failure to keep an active credit card on file will cause all lessons to be paused until a valid credit card is on file. First First Last Last Submit If you are human, leave this field blank.
