Registration

Piano and Guitar Academy | Register

Student Registration

Fill out the form to register you or your student for the Piano and Guitar Academy.

PLEASE NOTE: A REGISTRATION FEE PAYMENT OF $55 IS DUE UPON A PERMANENT LESSON SLOT BEING ASSIGNED TO THE STUDENT.

info@AVPianoAcademy.com

952-322-4329

Apple Valley Minnesota
Lakeville Minnesota

Student Full Name

Student Date of Birth (00/00/0000)

Parent 1 Full Name

Parent 1 Street Address

Parent 1 (City/State/Zip)

Parent 1 Phone (000-000-0000)

Parent 1 Email

Parent 2 Full Name

Parent 2 Street Address

Parent 2 (City/State/Zip)

Parent 2 Phone (000-000-0000)

Parent 2 Email

What instrument do you play or are interested in learning to play? Options: Piano, Keyboard, Guitar-Acoustic/Classical, Guitar-Electric, Guitar-Bass, Ukulele.

Is there an instructor you would like to be assigned to? Ex. Miss Laureen, Lance Larson, Paul Markert, Peter Duggan.

How did you hear about us?

We would love to thank the person who referred you! Please enter their full name:

In order to assign a weekly lesson slot, list at least 3 days and times that best fit your schedule.

We would like information about the instrument the student will be practicing on at home: Make (Brand), Model Number, and Approximate Year of Manufacture.

Describe any diagnosis of a learning disability or mental condition the student has; for example, ADD, ADHD, Autism, etc.

What device are you currently using to access our site?

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