Community Music School

Adult Piano Lesson Registration


Adult Piano Lesson Registration * need the valid information.

Your Information

Your Name:
* required



Student Age or DOB:

* required

DOB (this will help us with music selection)



Home Address:
* required



Home Phone or Cell Phone:

* required



Email:
* required



Piano Experience: Please briefly explain your piano history, if any (again, this will help with our planning)



Registration Confirmation

Permission to Enroll.

Date:

Registration Information

Checks payable to: Community Music School

Please make your checks payable to "WIU Community Music School" and give payment directly to the instructor at the first rehearsal of the semester.