Sign Up for Private Lessons Use the form below to sign up for private lessons. Lessons Signup Form 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) How do you want to pay * Whole Semester Monthly Pay monthly for the semester: Lessons are $90.00 monthly for a half hour lesson. There are 18 lessons in the fall semester. This works out to $25.00/lesson. Your credit card will be billed the 1st of each month August-December (students who choose this option will still be billed for the month of December even if they withdraw from lessons in November). Pay for the whole semester in advance and choose your schedule: Lessons are $25.00 a half hour. You select which weeks you would like to come to lessons. Must purchase a minimum of 10 lessons to choose this option. Thank you for choosing monthly payments. After submitting your information, we will contact you to arrange lesson times and send you a link to your student portal. Preferred Dates for Lessons * August 7th August 14th August 21st August 28th September 4th (No Monday Lessons this Week) September 11th September 18th September 25th October 2nd October 9th October 16th October 23rd October 30th November 6th November 13th November 27th December 4th December 11th Parent/Guardian First Name * Parent/Guardian Last Name * Cell Phone Number * Billing Address * Billing Address Billing Address Billing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Credit Card * Credit Card Credit Card Credit Card Month 123456789101112 Credit Card Year 20232024202520262027202820292030203120322033 Credit Card Total Cost $ 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 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 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 If you are human, leave this field blank. Submit
