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 (July and August Schedule) MONDAYS and TUESDAYS Katelyn Vanderbaan TBA Matthew Sowersby TBA Eleanor Blake TBA Brian Gionet TBA

Lesson Package