2020 Piano Lesson Enrolment Form - Adult Student
Kimberly's Piano Room
Email address *
Do you agree to my 2020 Studio Policies? *
Have a read before you start filling out the form or else clicking the link may delete your answers! Please do read them as they include important information about next year's fees. https://pianoroom.nz/wordpress/wp-content/uploads/2019/12/2020-Studio-Policies-3.pdf
Student's Full Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Phone Number/s *
Your answer
Home Address *
Your answer
Any medical conditions or learning difficulties I need to be aware of: *
Your answer
Student's previous/current musical education *
Your answer
Why are you enrolling in piano lessons? *
Your answer
What would you like to achieve through piano lessons in 2020? *
Your answer
How much practice do you expect to be able to do during the week? *
Your answer
What kind of piano/keyboard do you have in your home? *
Your answer
How do you feel about your 'buddy' situation? *
Please tick any times you would NOT be available for piano lessons in 2020
These are not exact lesson times, but are for me to see general times you would be available for lessons.
1:00
1:30
2:00
2:30
3:00
3:30
4:00
4:30
5:00
5:30
6:00
6:30
7:00
Mon
Tue
Wed
Thu
Fri
If I were to open up Saturday mornings, what would be your availability for that day? Tick any times you would NOT be available for lessons.
9:00
9:30
10:00
10:30
11:00
11:30
12:00
12:30
Sat
Any comments about lesson availability:
Your answer
What is the earliest time of day you could be at a lesson? *
Your answer
What is the latest time you could finish your lesson? *
Your answer
What are your ideal lesson times/days? *
I cannot guarantee anything, but will do my best to accommodate as many preferences as possible
Your answer
Is there any other info that would be useful for me to know so that I can provide the best lessons possible?
Your answer
Do you give permission for photos/videos taken in lessons to be shared for advertising purposes? *
There is a $35 registration fee due along with the form *
This is to hold your place in my schedule, and cover just a little bit of the work I do in January scheduling and planning for the year. My bank account details are on the Studio Policies document.
A copy of your responses will be emailed to the address you provided.
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