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Miss Mandy's Student Intake Form (New Students)
The most important information is: n
ame, birthday, grade level, parents’/guardians’ names, and the address where lessons will be held. Thank you so much!
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Student Name and Pronouns
*
Your answer
Student Birthday
*
MM
/
DD
/
YYYY
Age and Grade level (for this 2026-2027 school year)
*
Your answer
Home Address (where lessons will be held)
*
Your answer
Parent/Guardian 1: name, email, and phone number
*
Your answer
Parent/Guardian 2: name, email, and phone number
Your answer
Preferred method of communication
Text
Audio Message
Email
Phone call
WhatsApp
Other:
Clear selection
WiFi Password (needed if there’s no AT&T signal)
Your answer
Tell me about the adults in your child’s life who sing, play music, act, go to concerts, make videos, etc. Who are their music/performance/creativity mentors?
Your answer
What music does your child like to connect over right now? Movie musicals, favorite music in the car, music to fall asleep to, silly song dances, music they song or play by ear, etc.
Your answer
Are there any learning differences that I can accommodate? For example autism, ADHD, dyslexia, or physical disability. Everyone is welcome! Any major allergies (e.g. tree nuts)?
Your answer
Known off dates through the next month
Your answer
Student School Name
Your answer
Questions:
Your answer
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