Lesson Form
petershumusic.com lesson intake form
Email address *
ABOUT YOU:
Parent Name:
Your answer
Student Name:
Your answer
Phone Number: *
Your answer
Lessons for: *
Students Age: *
Previous Piano Experience (in years):
If Beginner, which piano method and level?
Your answer
Able to read music?
Play Another Instrument?
If Yes, how long and in what context?
Your answer
Do you sing?
If Yes, how long and in what context?
Your answer
Possible Goals: (just for fun)
Musical Styles that interest me:
Do you have a piano/keyboard?
If no, are you planning on getting one?
LESSON SPECS:
How often would you like your lessons?
Lesson Length:
Days Available:
Times Available:
How long would you plan on taking lessons?
Preferred Start Date:
Hiring Process:
Travel Preference:
Notes:
Your answer
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