Private Lesson Registration // Weronika Balewski Music Lessons

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

To reserve your weekly lesson time, you must a) pay full tuition or the first installment of tuition, and b) fill out this form.

Student Name (the way it will appear on a recital program) *

Parent/Guardian Name (If student is under 18)

Email *

Phone Number *

Instrument *

Flute

Piano

Lesson Length *

15 minutes

30 minutes

45 minutes

60 minutes

Age & Grade (or just write "adult") *

Student's School (or write "adult") *

Main Address (Street, City, Zip)

Second Address (if applicable)

Additional Parent/Guardian/Caregiver Contact Info

Student Email & Phone Number (If student is under 18)

Student Contact Permission (If student is under 18)

By providing the student’s phone number and/or email address, I give permission for Weronika Balewski to contact the student about matters related to the flute studio, including lesson times and practice assignments, as well as auditions and performance opportunities outside the studio. I understand that I have the right to see the teacher’s communication with the student at any time. I understand I have the right to request that I am cc’d on all texts and emails sent to the student.

I do not give Weronika Balewski permission to contact the student directly via phone or email.

Clear selection

2023-2024 Studio Policies

Studio Policy Agreement *

I have read and understand the studio policies.

Anything else you'd like to tell me?

Thank you!

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms