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Marin Piano Studio Student Registration Form
Please fill out the Registration Form, one for each student enrolling into piano lessons. Thank you
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* Indicates required question
Contact Information
Student Name
*
Your answer
Student Birthdate
*
MM
/
DD
/
YYYY
2nd Student Name and Birthdate (m/d/year) (if applicable)
Your answer
3rd Student Name and Birthdate (m/d/year) (if applicable)
Your answer
Student School & Grade (if applicable). If more than 1 student, please put each student's name, school & grade.
Your answer
Parents / Guardian Names (if student is a minor)
Your answer
Best Contact Phone Number
*
Your answer
Best Number for Optional FaceTime lessons:
*
Your answer
Contact Email (best one to receive studio events schedule, news updates, scheduling, etc.)
*
Your answer
Street Address
*
Your answer
City, State, and Zip
*
Your answer
Emergency Contact Info (Name, Relationship to Student, & Phone Number)
*
Your answer
Allergy Information:
*
(If none, please state none)
Your answer
Program in which you would like to enroll:
*
Accelerated After School Program (Children and Teens)
Preschool Program
Homeschool Program
Adult Program
Online Lessons: Skype or FaceTime
Other (please list details in comment box at bottom of this page)
Further comments or details about any responses, above:
Your answer
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