Student Name *

First Name

Last Name

Name of Guardian

If student is a minor

First Name

Last Name

Phone *

(###)

###

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Please understand that lesson times are limited. If you must cancel your appointment, I respectfully request 24 hours notice. Missed lessons, or appointments cancelled without 24 hours notice, will incur a fee of the total cost of the original lesson. *

By checking here, I have read and agree to adhere to the cancellation policy

STUDENTS MUST LET ME KNOW IF THEY ARE SICK. I cannot stress this enough. I am happy to have the lesson, but I need this information so I can provide masks and take any other cautionary measures for myself and my other students. IF I GET SICK, I CANNOT WORK, AND I DO NOT GET PAID. *

By checking here, I have read and agree to adhere to the sick policy

Signature *

First Name

Last Name

Date *

MM

DD

YYYY