Student Name

First Name

Last Name

Parent/Guardian Name:

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Instrument

Lesson Makeup Policy

I understand that missed lessons will only be made up in cases of teacher absence or weather cancellations.

I agree

Teacher

Schedule Preferences

Sylvia DiCrescentis Wednesdays and Tuesdays Katelyn Vanderbaan Tuesdays Matthew Sowersby Mondays Eleanor Blake Mondays Brian Gionet Thursdays and Fridays

Lesson Package