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Please use this form to REGISTER for anytime during the Term. Each Term runs from August 1 - May 30 each year. The times may adjust slightly based upon the school release times. Pinellas County will be releasing one hour earlier on Wednesdays this year. At present, Elementary Schools will release at 2:50 on MTThF, and 1:35 on Wednesday. Middle Schools will release at 4:15 on MTThF, and 3:00 on Wednesday. High Schools will release at 1:50 on MTThF, and 12:35 on Wednesdays. Please see Pinellas County Schools website for Fundamental Schools individual release times.
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STUDENT'S FULL NAME
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PARENT(S) NAME(S) - IF STUDENT IS NOT AN ADULT
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FULL ADDRESS, INCLUDING ZIP CODE
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EMAIL ADDRESS
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EMAIL ADDRESS BELONGS TO... (MAY SELECT MORE THAN ONE)
DAD
MOM
PARENTS
STUDENT
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COMPLETE PHONE NUMBER
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Phone Number is...
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STUDENT'S AGE
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STUDENT'S BIRTHDAY (MONTH, DAY)
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STUDENT'S T-SHIRT SIZE
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NAME OF SCHOOL STUDENT ATTENDS - IF APPLICABLE
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PIANO LESSON HISTORY
BEGINNING STUDENT - HAS NEVER TAKEN PIANO LESSONS
RETURNING STUDENT - TO THIS STUDIO
PREVIOUS PIANO LESSONS - WITH DIFFERENT TEACHER
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PREVIOUS PIANO TEACHING METHOD(S) USED, IF APPLICABLE
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I TOOK "BLAST OFF WITH PIANO" WITH MRS. HURST
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I AM AVAILABLE FOR CLASS ON (PLEASE CHOOSE MORE THAN ONE)
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
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I AM AVAILABLE FOR CLASS AT THE FOLLOWING TIME(S) on TUESDAY
1:00 - 1:45PM
1:45 - 2:30PM
2:30 - 3:15PM
3:15 - 4:00PM
4:00 - 4:45PM
4:45 - 5:30PM
5:30 - 6:15PM
6:15 - 7:00PM
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I AM AVAILABLE FOR CLASS AT THE FOLLOWING TIME(S) on WEDNESDAY
10:30 - 11:15AM
11:15 - 12:00NOON
12:00 - 12:45PM
12:45 - 1:30PM
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I AM AVAILABLE FOR CLASS AT THE FOLLOWING TIME(S) on THURSDAY
10:15 - 11:00 am
11:00 - 11:45 am
11:45 am - 12:30 pm
12:30 - 1:15 pm
1:15 - 2:00 pm
2:00 - 2:45 pm
2:45 - 3:30 pm
3:30 - 4:15 pm
4:15 - 5:00 pm
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I AM AVAILABLE FOR CLASS AT THE FOLLOWING TIME(S) on FRIDAY.
11:00 - 11:45am
11:45 - 12:30pm
12:30 - 1:15pm
1:15 - 2:00pm
2:00 - 2:45pm
3:00 - 3:45pm
3:45 - 4:30pm
4:30 - 5:15pm
5:15 - 6:00pm
6:00 - 6:45pm
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As part of my Registration, I have read, printed, signed, and mailed the Agreement found on a separate web page.
YES
NO
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PLEASE SELECT ONE
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I FOUND OUT ABOUT YOUR STUDIO THROUGH
REFERRAL (SEE BELOW)
NEWSPAPER AD
MAGAZINE AD
PIANO DISTRIBUTORS WEBSITE
THIS WEBSITE
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I WAS REFERRED BY (NAME)
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COMMENTS OR QUESTIONS ABOUT THIS REGISTRATION
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