Registration for Piano Fun Group Lesson for Littles 
This is a one-lesson trail form that will be updated upon the commencement of a formal teaching arrangement. 
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Email *
Please choose which program you are interested in. *
Required
Student Name *
Date of Birth  *
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Parent Name  *
Email Address 
Mobile Phone Number *
Emergency Contact Name and Mobile Phone Number *
Please check all your preferred time slots. 
All winter session classes will be held on Saturday.
All classes last 45 minutes. 

 *
Required
It would be helpful if you knew the following about my child *
Media Consent

I hereby grant permission for images and/or audio/video recordings of myself and my child(ren) to be posted on the MDA Piano Academy Website, MDA Piano Academy Facebook Page or included in studio publications with the first name attached.
 *
Required
By registering with MDA Piano Academy,  you authorize  MDA Piano Academy Piano Fun Group Lessons for Littles to add your email address to the Studio’s mailing list to receive lesson follow-up information, Studio News and Term Newsletters. Your email will not be shared. 

I consent to my email address being added to the MDA Piano Academy mailing list. 
 *
By completing and submitting this enrolment form you are agreeing to MDA Piano Academy’s Group Lesson Policy. Policy available here.  I have read and agree to MDA Piano Academy’s Group Lesson Policy. *
Thank you for submitting!
You will receive confirmation shortly.

Mariko Avanesian
MDA Piano Academy
Mdapianoacademy@gmail.com
647-505-1661
A copy of your responses will be emailed to the address you provided.
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