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Interested in lessons but would like more information about my studio? Click here.

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Parent's Name *

First

Last

Your Email *

Phone Number *

Instrument you have in your home: *

Piano Keyboard - 76 keys or bigger Keyboard - Smaller than 76 keys

I can commit to lessons for the full school-year and 100 minutes of practice per week. *

Yes No

Student's Name *

Student's Birthdate *

Number of years student has played. *

Other Instruments Student Plays *

Does Either Parent Play the Piano? *

Days and Times Available for Lesson: *

Who do I thank for referring you? *

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