Registeration form (1-on-1 piano) — Miralles Music Academy

Registration Form

Complete the Step One of the Registration: Fill in your parent/guardian information on this form. You will then proceed to complete:

Step Two: Student information

Step Three: Confirm your subscription on your email. Scheduling your weekly lesson

Step Four: Set up direct debit payment

Full Name [Parent/Guardian/Adult Student]

First Name

Last Name

You are registering as...

Is this your first time enrolling in music lessons?

Gender

Phone

(###)

###

####

Address Section:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

REFERRAL SOURCE *

if you were referred by a friend, please specify on the notes box below.

Notes*

Who's the name of the person that referred you? How did you found out about my lessons?

I consent to the Terms and Conditions and Privacy Policy

I Consent