Parent or guardian name *

First Name

Last Name

Alternate parent or guardian name, if applicable

First Name

Last Name

Parent or guardian phone number *

(###)

###

####

Alternate parent or guardian phone number, if applicable

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student name *

First Name

Last Name

Student birthdate *

MM

DD

YYYY

Lesson duration and school-year frequency

30 minutes, every week

45 minutes, every week

45 minutes, every other week

Unsure: let's talk!

Permission to use student's photo/video? *

The most common use of your student's photo would be when they complete a book or achieve an impressive milestone, it's posted on the studio Facebook page.

Yes

No

I've read the parent information for this year. *

https://www.lakestreetpianostudio.com/parent-information

Yes!