Register for piano lessons Student Name * First Name Last Name Student Age * 5-8 9-12 13-17 18+ Parent Name (if different) First Name Last Name Email * Phone * (###) ### #### Preferred Communication Method * Text Email Call Desired Start Date * MM DD YYYY Are you able to attend lessons in-person in Centerton, Arkansas? * Yes Yes, but I would prefer remote lessons No, I can only do remote lessons Weekly Availability (lessons are mostly taught in the afternoon/evening) * Monday Tuesday Wednesday Thursday Friday Current Experience Level * Novice (No piano experience) Beginner (<2 years) Intermediate (2-4 years) Advanced (5+ years) Optional: Additional Background/Relevant Information Thank you! I will contact you within 2-3 days to schedule a first lesson. Fill out the registration form below and I will reach out to you to schedule a first lesson!