Private Lesson Registration // Weronika Balewski Music Studio

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To reserve your weekly lesson time, you must a) pay full tuition or the first installment of tuition, and b) fill out this form. If you are a returning student and I already have your address and additional contact info, please feel free to skip that.

Student Name *

Parent/Guardian Name (If student is under 18)

Email *

Phone Number *

Instrument *

Flute

Piano

Lesson Length *

15 minutes

30 minutes

45 minutes

60 minutes

Lesson Format *

In Person

Online

Is the student fully vaccinated against Covid-19? *

Yes

Notes about vaccination (optional)

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

Student's School (If student is under 18) *

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

Studio Policy Agreement *

I have read and understand the studio policies. I understand expectations for practice and required materials/equipment. I understand expectations for group class attendance and recital participation.

Anything else you'd like to tell me?

Thank you!

Submit

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