Registration Form

This form will register you for the 25-26 academic year.

Fall Semester: September 2 - December 12

Spring Semester: January 12 - June 19

Student Information

Student Type

Student Name

First Name

Last Name

Student Birthday

YYYY

Pronouns

he/him, she/her, etc.

Lesson Length

Skill Level

Parent Information

Parent Name

First Name

Last Name

Parent Email

Parent Phone

(###)

###

####

Availability

Be as specific as possible! All days/times that you are available for a lesson.

Billing Frequency

I give Prime Piano Studio permission to use mine/my child's photo/video for promotional purposes.

I agree

I do not give permission

I agree and accept the Studio Policy.