Registration Form

Student Name

First Name

Last Name

Parent or Guardian 1

First Name

Last Name

Parent or Guardian 2

First Name

Last Name

Address

I am currently offering in-home lessons in the Greater Boston Area.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Email Address

Parent Phone Number

(###)

###

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Lesson Plan

Please select the lesson plan that best suits your child's education goals this semester. Monthly tuition is paid in advance by Venmo, cash, or check at the first lesson of each month.

Scheduling Options

Please select all scheduling options below that would work for your family. If none of these options are feasible, please briefly describe your availability and scheduling constraints in the comment box below. I will follow up with you to discuss and confirm your lesson plan this semester. Thank you!

Weekday mornings

Weekday afternoons

Weekday evenings

Weekend mornings

Weekend afternoons

Weekend evenings

Scheduling Details

Please use this space to describe your family's scheduling needs and lesson plan preferences in more detail.

Educational Goals

Please describe your interest and goals in studying piano with me.

Checkbox

By checking the box below, I confirm I have read and agree to Rachel Ice’s Studio Policies in full, including those regarding attendance, absences, payment, and lesson preparedness. Please note, I reserve the right to decline lesson requests for any reason at my sole discretion.