Piano Prodigies Registration 2018-2019
Required for all students (new and returning)
Email address *
Student First Name *
Please use name that you prefer for printed programs (official name or nickname)
Your answer
Student Last Name *
Your answer
Student Date of Birth *
Please select Month, Day, and Year of Birth
MM
/
DD
/
YYYY
Grade in School this year
Your answer
Name of School
Your answer
T-shirt Size *
Piano *
Make/Model of piano and last tuning date (if acoustic)
Your answer
Parents *
First and last names of parent(s)
Your answer
Parent Email Address *
Preferred email address(es) for announcements, reminders, lesson scheduling, etc.
Your answer
Parent Cell Phone Number *
Your answer
Home Address *
Include street address, city, state & zip code
Your answer
I have read and agree to the conditions outlined in the Piano Prodigies studio policies. *
Required
Photo/Video Release *
I hereby authorize Piano Prodigies to use, reproduce, and/or publish photographs and/or video of the above-named student (taken during workshops or recitals) without compensation.
Comments and/or Questions
Your answer
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