Prospective Student Registration Form
Thank you for your interest in Resonance: Mind-Body-Music, LLC! All classes and lessons are held either online (during COVID-19 pandemic) or at 112 N. Main Street, Pearl River, New York inside Good Shepherd Lutheran Church (when safe to return to in-person lessons). All levels and backgrounds are welcome!

Please fill out the following registration form. Thank you!
Student's Name *
Parent/Guardian Name(s) *
Student's Birthdate *
Student's Grade *
Best Cell Number *
Alternate Phone Number
Email to correspond with Dr. Burns *
Email where invoice should be sent (if different from above)
Student's interests *
How did you hear about Resonance: Mind-Body-Music? Referred by?
I am interested in: (please check all that apply) *
Required
Please describe your musical background, if any. *
Do you have a piano at home? If so, what kind? (No piano at home/Digital piano/Upright piano/Grand piano) *
Can you and your child commit to spending time at the piano each day? *
What are your best days and times for piano lessons? *
Any other comments that might help me as I prepare for our lessons together?
Media Release: Resonance students are often featured on social media, on our studio website, and in posters and brochures. Photos and videos may be taken at lessons, at studio events, and at recitals throughout the year. Do we have your permission to post photos/videos of your child? Names are not used in these posts. *
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