New Student Form

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New Student Form

Email *

Student's name *

As it is to appear on the recital programs.

Student's age *

Student's birthday *

month/day/year

Parent's names *

Number of siblings *

Address *

Student's mailing address

Phone number *

(000) 000-0000

Cell number *

How frequently do you typically check your emails? *

Once a day or more

Once a week

Once a month or less

Required

Email address *

Google ID (if you don’t have one currently, please create one): *

Allergies or dietary restrictions? If yes, please explain. *

Does the student homeschool? *

Reason: Could the piano lesson take place 8am-3pm?

Yes

Required

What church do you attend? *

Would you be willing to research the possibility of us having a recital there? *

Yes

Required

Has student ever taken piano lessons before? *

If yes, how many years, what level is the student, etc.

What Instrument do you want lessons for? *

Piano

Violin

Guitar

Other:

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