Piano Lessons Registration Form



Parent's Name*
Your Email Adddress*
Home Phone*
Work Phone
Cell Phone
Home Address*
City*
State*
Zip Code*
Single Lessons
 Not Enrolled 
 Individual Lessons - 1 hr ($30) 
 Individual Lessons - 1/2 hr ($15) 
 Individual Lessons - 3/4 hr ($24.50) 
 Partner Lessons - 3/4 hr ($12.25) 
Piano Semesters
 Not Enrolled 
 Fall, Winter, Spring Semesters 
 Summer Semester 
Semesters Payments
 Not Enrolled 
 Fall Semester (1/2 payment) - $75 
 Fall Semester (Full payment) - $150 
 Winter Semester (1/2 payment) - $75 
 Winter Semester (Full payment) - $150 
 Spring Semester (1/2 payment) - $75 
 Spring Semester (Full payment) - $150 
 Fall, Winter, Spring Full Payment - $450 
 Summer Semester - $80 
Child's Name*
Child's Age*
Comments
Payment Method*
  Paypal (Please print a copy for your records and click Submit) 
  Check Payable to Barlow Productions, LLC, 371 W. Main St., Fredonia, NY 14063 (Please print a copy for your records, mail a copy with your check, and also click Submit). 

Payment is due within 4 business days of the submission of this form. Your child's slot will not be reserved until receipt of a deposit or full payment.
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