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Student Information Form
This form provides needed information and gives William some background on the student
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* Indicates required question
Student Name
*
Your answer
Nickname(s)
Your answer
Preferred Pronouns
He/Him/His
She/Her/Hers
They/Them/Theirs
Other
Prefer Not to Answer
Clear selection
If other, please provide:
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
School
*
Your answer
Grade Entering in Upcoming School Year
*
Your answer
Street and Mailing Address
*
Your answer
Parent(s) Name(s)
*
Your answer
Phone Numbers - Please state if it is cell or home
*
Your answer
Emails
*
Your answer
Preferred Method of Contact
*
Cell
Text
Home
Email
Emergency Contact Name and Phone Number
*
Your answer
Allergies or Other Health Concerns
Your answer
How did you hear about the studio?
Your answer
Student's Musical Background
Your answer
Previous Years of Piano Study
Your answer
Is a keyboard instrument available to practice on?
*
Yes
No
Is an adult available to help the student during their practice sessions as needed?
Yes
No
Clear selection
Are there any family religious beliefs that might impact repertoire choices? If so, please explain:
Your answer
Is the student looking forward to taking piano lessons?
Yes
No
Somewhat
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Hobbies or interests
Your answer
Extra-curricular Activities
Your answer
Will any activities prohibit the student from practicing every day?
Your answer
Any other concerns or comments?
Your answer
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