First name

Last name

Parent's First Name (if minor)

Parent's Last Name (if minor)

Email

Phone

About You:

Lessons for:

Myself (one-on-one)

My Child

Student Age:

Previous Piano experience (in years):

No Experience

0-5 yrs

6-10 yrs

10+ yrs

If Beginner, which piano method and level?

Able to read music?

Yes

No

Play another instrument?

Yes

No

If Yes, how long and in what context?

Do you sing?

Yes

No

If Yes, how long and in what context?

Possible Goals: (just for fun)

Musical Style(s) that interest me: (check all that applies)

Do you have a piano/keyboard?

Yes

No

If no, are you planning on getting one?

Yes

No

As recommended by teacher

Lesson Specs:

How often would you like your lessons?

Weekly

Bi-weekly

As recommended by teacher

Lesson Length:

30 minutes (@ $100/hr)

60 minutes (@ $100/hr)

Days Available:

Times Available:

Mornings (9am to noon)

Afternoon (2pm to 6pm)

Evening (6pm+)

How long would you plan on taking lessons?

Try it out (1-4 times)

1-3 months

1-3 years

ongoing

Preferred Start Date:

Immediately

Within the next 1-2 weeks

Next school term (semester)

Hiring Process:

Ready to hire the right teacher now

Doing my research

Just thinking about taking piano

Promo Code:

Notes: (anything further you'd want the teacher to know about you.)

Product

Lesson Deposit - half hr weekly$200

Lesson Deposit - one hr bi-weekly$200

Lesson Deposit - one hr weekly$400

Start Lessons

About You:

Lesson Specs: