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) 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 October 14th October 21st October 28th November 4th November 11th November 18th December 2nd December 9th 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 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 Submit If you are human, leave this field blank.
