Register for Piano Lessons Student's Name * First Name Last Name Date of Birth * MM DD YYYY Student's Age * Student's Current School * Student's Current Grade * Is your student new to Tessitura Music? * Yes No Parent's Name * if student is under 18 First Name Last Name Email 1 * Email 2 Student or 2nd Parent Phone 1 * (###) ### #### Phone 2 Student or 2nd Parent (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact * First Name Last Name Emergency Contact Phone * (###) ### #### Medical or Health Concerns Please describe any concerns that might hinder participation. Select Lesson * Piano Lessons Form of Payment Payment due by First Lesson (Payment Plans Available) Venmo Check Cash How did you hear about us? Reasons for choosing this class: Comments Please list your questions and anything else we need to know. Thank you! We be in touch within 24-48 hours to follow up on piano lessons!
