New Student Registration
Name
First Name
Last Name
Parent or Guardian (if under 18)
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Date of Birth
 -
Month
 -
Day
Year
Date
Why do you want to take this lessons?
Do you have any experience?
Do you have any health issues I should know about? (Allergies, acid reflux, vocal injuries, etc.)
What goals would you like to focus on in your lessons?
Improving Communication Skills
Time Management and Organization
Critical Thinking and Problem Solving
Cultural Awareness and Sensitivity
Vocabulary Expansion
Grammar Mastery
Reading Comprehension
Other
What length of lesson would you like to take?
30 minutes ($25)
60 minutes ($40)
How often would you like to take lessons?
Once per week
Once every other week
Once per month
Other
Is there anything else you’d like me to know?
What is your payment preference? Lesson payment for the month is due at or before your first lesson of each month.
PayPal
Cash
There is a 24 hour cancellation policy, so please let me know at least 24 hours before your appointment if you need to cancel or reschedule. There are no refunds for cancelled lessons. There is studio credit for all lessons that have been cancelled with more than 24 hours notice, which may be rescheduled. Please remember the full rate is charged for any lesson that is cancelled or rescheduled with less than 24 hours notice.
I have read and agree to the 24 hour cancellation policy.
I’d like to stay in touch with you! I promise to only send you emails regarding being a student of my class or information which will have value to you as a student.
Yes, I agree to be added to the email list and I understand I can unsubscribe at any time.
No, I do not want to be added to the mailing list.
Submit
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