Contact Information
All information collected are strictly confidential.
Student's First Name *
Student's Last Name *
Parents / Guardian's Name(s) *
Phone Number *
Email (optional)
Student's Age *
Student's Birthday
MM
/
DD
/
YYYY
Which school is the student currently studying? *
Which suburb do you live in? *
Preferred Lesson Types *
Required
Current Music Level *
Preferred Lesson Day *
All choices are subjected to availability.
Required
Preferred Lesson Time *
All choices are subjected to availability.
Required
Previous Piano Teachers / Academy *
Eg: Canterbury Music, Vivace Piano Academy etc. OR None
Lastly, how did you hear about us?
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