Student/Recipient Name *

First Name

Last Name

Parent/Guardian/Giver Name

(Required if under 18)

First Name

Last Name

Desired Amount:

$125 (1 month of lessons for 1 person)

$225 (2 months for 1 person, or 1 month for 2 people)

Other amount

Date of Birth

(Required if under 18)

MM

DD

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have access to an instrument? *

Yes

No

I would like information about borrowing an instrument from the Harmonny Lending Library

Which days and times are best for scheduling?

Weekday Mornings

Weekday Afternoons

Weekday Evenings

Saturday Mornings

Saturday Afternoons

Studio Policy Bullet Points:

• Please arrive punctually and prepared for your lesson. • You must contact your instructor at least 24 hours BEFORE your lesson to report a cancellation or to reschedule or you may forfeit the lesson for that week. 24-hour notice is not required for illness or emergency, please call as soon as you can. • If weather conditions do not permit safe travel at the time of your session, lessons may be made up later or conducted remotely. Contact your instructor if you are unsure.

I have read and understand the above policies. More information is provided in the link at the bottom of the page.