Student Information Form
Please fill out the following information so I have a better understanding of your child & their interest in music and/or the piano.
Student's Name *
Birthday *
School/District/Grade *
Student's Hobbies/Interests *
Extracurricular Activities *
Student's Musical Background *
Which lesson are you most interested in for this student?
1st Choice
2nd Choice
3rd Choice
Beginning Piano Lessons
Intermediate/Adult Piano Lessons
Group Music Lessons
Other (please add comments at end)
Do you have another student to add?
Clear selection
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