Piano Lesson Enrollment Form
Filling out this information will ensure a smooth registration process for all students.  Thank you!
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Email *
Name of Parent
Phone Number & Email
Name of Student
Address
Date of Birth
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/
DD
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Availability for lessons.  Please check times that are NOT possible for lessons.  Afternoon is 1:30-5:30.  Evening is 5:30-8:30.
Please briefly describe any special learning needs or considerations.  Include relevant allergies.
Does anyone in the household have experience with music training?
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List other activities, hobbies, or interests of the student.
What type of piano do you have at home?
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