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MIND the MUSIC! Senior Adult Piano Lesson Form
The Haywood County Arts Council is sponsoring a piano class for adults, age 55 and older, who wish to learn to play the piano. The class will run for five weeks, beginning late September 2017. These lessons are ideal for older adults who may have taken piano lessons as children but did not continue, and for those adults who never took lessons by who now want to learn. Students are invited to learn in a no-stress environment, with small classes of 2-4 people only. The cost for the one session of five classes is $60, plus a materials fee (less than $20).

Please answer the following questions, and we will be in touch! Thank you for your interest.

First Name
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Last Name
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Street Address
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City
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State
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Zip Code
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Phone Number(s)
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Email Address
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Have you ever taken piano lessons before?
If yes, when and for how long did you take lessons?
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Do you play, or have you ever played, another musical instrument?
If you play/have played another instrument, which instrument and for how long?
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Would you classify your piano playing level as absolute beginner, beginner or advanced beginner?
Do you own or have convenient access to a piano or electronic keyboard?
Are you involved in any music groups (singing or instrumental) at the present time? If so, what group(s)?
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Have you taken MIND the MUSIC! lessons with Susan Huckaby before?
Other comments/questions/information:
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