Private Lesson Registration

* Indicates required field

Student's Name *

First

Last

Parent's Name (if applicable) *

First

Last

Parent's name (continued, if applicable) *

First

Last

Any other adult who will be involved in drop off/pickup *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Select One *

Whose phone number? *

Select One *

Whose phone number? *

Email *

Select One *

I prefer to be contacted via: *

Email Text Phone

Student's birthday *

Student's grade in school 2024-2025 *

What would you like to see your student accomplish this year in lessons? What does your student want to accomplish this year in lessons? *

What should Renee know to help your student be successful in reaching their goals? *

Submit