Ready to Sign up for Piano Lessons?
The purpose of Introductory Lesson are for us to get to know each other. Due to the long-term mentoring, one-on-one nature of piano lessons, it's very important that we keep the golden triangle of “Parents-Student-Teacher” in same goals, similar values, and compatible personalities.
What is a "Best" and IDEAL" time for you to come for piano lessons?
Studio is now at almost full capacity, the open slots are very limited. Try your best to give me your available time, if there is no slots for you, then you will be put in a waiting list. I will contact you as soon as your desire time become available again. Thank you so much!
For example - Monday and Tuesday between 3pm to 5pm only. Saturdays only etc. Please be specific so that I can find your perfect slot for you.
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Basic Information
Name of Student *
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Father's Name *
If Adult student, write your own name here
Your answer
Mother's Name *
If Adult student, write your own name here
Your answer
Home Address *
No POBox please
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Father's Phone Number *
Prefer cell phone number
Your answer
Can I text message to your cell phone? *
Mother's Phone Number *
Prefer cell phone number
Your answer
Can I text message to your cell phone? *
Father's Email Address *
Your answer
Mother's Email Address *
Your answer
About student
Birthday *
Current School Grade *
Current School's Name *
If adult student, please mention your occupation, or if retired
Your answer
Has this student ever studied music before? *
If yes, please describe in detail (where, what instrument, what program, how long, with which teacher?)
Your answer
If this student studied piano before, what is the reason that you are changing teacher?
Relocation, do not like current teacher, need to seek better teacher etc....
Your answer
What is the reasonable of piano practice time the student willing put in per week? Teacher is going to customize your homework load according to the amount of time you willing to practice. Let's say you willing to practice 20 minutes but only 3 times in a week, then you take 20m x 3 = 60m. Then you write 60m per week. *
Your answer
How much does this student want to take piano lessons? *
About goals
Please list piano books you currently own (method— include levels, anthologies, etc.) Please indicate what books the student has most recently worked from.
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What is your goal for having your child or yourself take piano lessons? *
Your answer
How long do you expect it will take your child or yourself to reach your goals? *
Your answer
If you can play any song/ piece to impress your families and friends, what would that be? *
Your answer
Are you interest in Certificate of Merit Piano Test Program? *
Is there any type of music you will not allow your child or yourself to study? If yes, please specify type and reason.
Your answer
Parent's Roles
If adult students, please assume you are your own parents.
Will one parent be available during lesson time to participate/observe as needed? *
Will one parent be willing and able to spend at least 15 minutes of time a day with the student to aid and encourage them in practicing? *
Would parent promise to keep communication channel always openly and promptly with teacher with all problems and concerns? *
Piano Information
Please describe your piano *
grand? upright? digital? electric keyboard? make? model? in tune?
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Do you have CD player? *
Do you have metronome? *
Emergency Information
Does this student have any dietary restrictions or allergies
Your answer
Does this student have any physical, mental, or developmental issues pertinent to taking lessons? Please describe in detail.
Is your child ADD, ADHD, dyslexia, perfectionist, very sensitive, anger management issue, autism etc...I need to know in advance to cater my curriculum to your child!
Your answer
Are you or any of your family members will be present at the studio allergy to cat? *
Please write yes, no, I do not know and follow with the precaution you like me to take to protect you.
Your answer
Piano Tuition
As a member in good standing with the Music Teacher Association of California, there are certain guidelines to which I strictly adhere regarding missed lessons, the billing process and late fees. These guidelines are consistently maintained, and cannot be altered as they allow the business portion of piano lessons to flow smoothly and equitably. Currently, my rates for piano lessons are as follows:
After the trial lessons, if you like my studio, please select your piano lesson duration and weekly tuition fee *
Rescheduling Policy after official sign up
Going to miss piano lessons due to summer traveling, sickness, birthday party, sports etc?

Introducing Unlimited Make Up Lesson. It is very easy!
1 Cancel by text/email at least 2 hours in advanced
2 Receive piano credit at
3 Book make up lesson online at

1. To reschedule an appointment, a minimum of 2-hour advanced notice by email or text is required.
2. Otherwise, clients have to responsible for the financial lost.
3. If privacy is needed, reasons for reschedule can be omitted.
4. Please use to reschedule.
5. Credits will be valid for ONE YEAR with uninterrupted paid enrollment.
6. Credits cannot be used to reduce tuition for the next invoice.
7. A make up lesson cannot be rescheduled again!
8. No credits or refunds for the cancelled make up lessons.
9. View valid credits at
10. Studio is operating year round; therefore attendance is expected during summer months.
11. Re-enrollment fee is $200 to put client’s name back on studio roster.
12. One month paid written notice needed to terminate this policy.
13. Paying for service means abiding to this policy


Would you agree with this studio policy? *
Parent's Electronic Signature
Please type your full name and follow by today's date to act as an electronic signature *
For example: George Washington, July 17, 2014
Your answer
How do you learn about me? *
Your answer
Do you have a discounted Voucher Number? *
If yes, please enter below, it is an eight digit number below the bar code. If no, enter "NONE"
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