Student Name *

First Name

Last Name

Date of Birth

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number *

(###)

###

####

Emergency Phone Contact

(###)

###

####

Parents/Guardians

First Name

Last Name

Parents/Guardians

First Name

Last Name

Private Lessons

30 minute lesson $45 per lesson

45 minute lesson $70 per lesson

60 minute lesson $90 per lesson

Private Lessons and Enrichment

30 minute lesson + 15 minute enrichment $65 per lesson

Buddy Lessons

Tuition is listed per student.

45 minute lesson $35 per lesson

IF YOU'RE TAKING A BUDDY CLASS, PLEASE INDICATE YOUR BUDDY.

If not, skip to the next question.

First Name

Last Name

Lesson Location

In Person or Virtual

In Person

Virtual

JOYFUL SOUNDS PIANO (Ages 3-5)

45 minute class $22 per lesson

BEGINNER GROUP PIANO (Ages 4-6)

Thurs 3:00-3:45pm **4 student limit**

45 minute class $32 per lesson

BEGINNER GROUP PIANO (Ages 6-9)

Tues 3:45-4:30pm **4 student limit**

45 minute class $32 per lesson

PHOTO WAIVER

Occasionally. Rivertown Music prints and publishes promotional materials. Please select appropriately:

Yes, I grant Rivertown Music to use my photos and/or my child's photos.

No, I do not grant Rivertown Music to use my photos and/or my child's photos.