Private Lesson Request
To register for a private lesson, you must complete and return this request form a minimum of one week prior to your requested date.  

For a semi private lesson, a request form should be completed for each student.  Please indicate the names of additional students in the "special notes" section.

After the request has been received, you will be contacted to confirm your dates/times.  You will be provided with a program code that will enable you to register online or in person.

Registration and payment must be received prior to the start of the private lesson.
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Email *
Contact Name
Phone Number
Email
Student Name
Student Age
Private or Semi-private:
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Type of lesson requested:
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First Choice:  
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Date requested:
MM
/
DD
/
YYYY
Second Choice:
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Date requested:
MM
/
DD
/
YYYY
Special Notes:
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