Application for individual instruction

To enroll in private lessons, please fill out the form below.  If you have questions, please call 971.238.4591.  Please read the private lesson policies available here.  Private lessons will be billed for their full tuition every quarter.  After the third class there will be no refunds of tuition. 

You will be contacted shortly after filling out this form to discuss scheduling.

Student Name *
Student Name
Parent Name (If Applicable)
Parent Name (If Applicable)
Student Birth Date *
Student Birth Date
Phone Number *
Phone Number
I aim to represent everyone properly at recital time. Please give me any helpful hints you can offer about how to properly pronounce your (or your student's) name. Ex. "Cole, like Dole bananas but with a C instead of a D." If you have performed in a previous PGS recital and your name has been correctly announced, you may omit answering this question.
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Please list your availability. Please note, the more flexible you are with your availability with enable me to place you in the most appropriate ensemble possible.
Photo Release *
Private Lesson Payment Policy *
Private lessons will be billed for their full tuition every quarter. After the 3rd class there will be no refunds of tuition.
ex. My daughter is studying "Smells Like Teen Spirit" and "Enter Sandman" with her private instructor. She is listening to the band Lettuce a lot.