Student Information

Last Name.

First Name.

Birthdate (xx/xxx/xxxx)

Grade

Street Address

City

State

Zip Code

Phone (xxx-xxx-xxxx)

Email

Most individual lessons are instructed through Zoom at no additional charge. Zoom lessons have two online instructors for personalizeed individualized lessons.

We do have onsite lessons at the student's home in central Florida. Prices vary depending on the amount of hours purchased and travel time. All paid deposits are non-refundabler. Please use a separate registration form for each student. Parents that wish to pay cash onsite, may make arrangements for such an option. The fee is negiotable.

Options

Zoom Lessons
All lessons have two certified online instructors. Please pay online by credit card. All lessons include a ten minute progress report to parents after the end of the session. Put the number of packages purchased next to each option.
-

	Hourly Payment ($40)
	Five Hour Package ($160)

What subject or topic?

Onsite Lessons
Please pay online by credit card. All lessons include a ten minute progress report to parents after the end of the session. Put the number of packages purchased next to each option. Payment may be adjusted for distance traveled.

	Hourly Payment ($50)
	Five Hour Package ($200)

What subject or topic?

ADJUSTMENTS

Surcharge

Reason

Discount

Reason

Payment Information

Prices are subject to change without notice.

Our orders are processed by PayPal. Once your form has been submitted you will be forwarded to PayPal where you will then enter in your payment information. Do not press return until you are ready to order or your purchase will be duplicated at a later time.