Lessons Registration

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Refunds available until three days prior to your first lesson

Student Information
Student Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Age*
Gender
Ethnic Category
For analysis purposes only.
Phone*
Email*
Enter Email Confirm Email
School*
If not in school, please enter None
Parent Information
Parent/Guardian Name
First Last
Phone
Email
Enter Email Confirm Email
Lesson Information
Lessons*
Pacific Crest will match you with one of our private instructors; however, if you wish to request a specific instructor, you may enter their name in the next field. We will do our best to accommodate you.
Instructor Requested (optional)
Promotional Code
Lesson Type*
Lesson Type - Grant Funded*
Private Lesson Terms
Schedule*
I/We agree
Lessons must run on schedule in order to not interrupt the flow of other lessons scheduled with the same teacher.
Missed Lessons*
I/We agree
Missed lessons may be made up at another time, but no refunds will be granted.
Instructor Assignment*
I/We Agree
Pacific Crest reserves the right to reassign a private music lesson student to a different instructor if necessary.
Cancelled Lessons*
I/We Agree
If the lesson cannot start on time, it will not be cancelled for a period of up to the first 10 minutes. If the lesson does not commence within the first 10 minutes, all parties agree to treat the tardy as a missed lesson and agree to arrange a make-up lesson.
Student Signature*
Enter full name.
Parent Signature*
Enter full name.
Signature*
I/We Accept
I/We understand that checking this box constitutes a legal signature confirming that I/we acknowledge and agree to the above terms of the Pacific Crest Private Lessons Program.
Payment
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Address*
Street Address City State ZIP Code

If paying by credit card, this address must match the billing address for your credit card.
Cardholder Email*
Enter Email Confirm Email
CAPTCHA
Credit card approval requires that the billing address, including Zip code, match the information on your credit card billing statement.
Name
This field is for validation purposes and should be left unchanged.

Student Information

Parent Information

Lesson Information

Private Lesson Terms

Payment