Limited Time Offer: Get 2 Months of ABCmouse.com for only $5!

Contact

Get your son or daughter into piano!
 
Hurry up Summer is upon us and room is limited!
 
Please fill out this application easily by copying and pasting into an email and send it to 
 
leekassandra@hotmail.com
 

 
Piano By Kassandra
Private Piano Lessons
Sign Up
 
 Parents / Guardian
 
First Name _____________________________               Last Name________________________________
 
Childs' Name ___________________________                BOY         GIRL      (please indicate)
 
Age of Child _________
 
Address _______________________________________  Phone Number _____________________
 
Email __________________________________  Cell Phone ________________________________
 
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If your son/daughter has NOT had any pervious experiance please note that here:    YES      NO
 
If your son/ daughter has pervious piano experiance please let me know here: 
 
 
Please List of any former Piano Knowledge that your son/daughter knows
_____________________________________________________________________________________________
 
_____________________________________________________________________________________________
 
_____________________________________________________________________________________________
 
What Grade is he or she in? ___________________
 
What books have they use? _________________________________________
 
LESSON SELECTION AND OPTIONAL TIME AND DAY REQUEST
 Check off the one you wish to have
 
30 Minutes _______             45 Minutes _________               60 Minutes __________
 
Sunday ________                 Tuesday _________                   Wednesday __________                Friday ____________

Possible Time Requesting _______________________________
Get 2 Months for $5!