A la carte lessons booking form
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Student’s full name *
Email *
Address *
Phone number *
Sudent’s age/grade *
Which a la carte menu are you booking?
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Please list at least two possible dates and times for your lessons.
 *
Let's talk suitable instrument.  Students can not learn on a toy. That would be like trying to learn the flute on a kazoo.  Do you have a tuned piano or and 88 keyed fully weighted keyboard?  
 *
Please indicate any previous music/piano lesson that you have had. *
First and last name
Required
Current Skill Level *
Required
Media Consent

I hereby grant permission for images and/or audio/video of myself and my child(ren) to appear in marketing materials for MDA Piano Academy.
 *
Required
A la carte piano lessons policy

You can book your lesson whenever you’d like, within my availability.
The lesson will be held either in person or online.
The tuition fee must be paid in full upon confirmation.
There are no refunds or reschedules on paid lesson fees.
Please book your lesson a maximum of 48 hours in advance. 
Please be aware that the lesson fee will be fortified in the event of a no-show and won’t be rescheduled.
Privacy policy 
Name, e-mail address, address, telephone number, etc. received from this form
The purpose of the use of personal information and the contents of your inquiry are as follows:
 
  1. Responding to and confirming opinions, requests, and inquiries
  2. Sending various materials, such as catalogs
  3. Analysis for product and service improvement
 
At the MDA Piano Academy, we will prevent the leakage of your personal information.
Other necessary and appropriate measures shall be taken for the safe management of personal information.
Unless there is a legitimate reason based on laws and regulations,
We will not use it for any purpose or disclose or provide it to third parties without your consent.
You will receive a reply shortly.
Thank you for submitting!

Mariko 
MDA Piano Academy
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