Anita's Piano Studio - New Student Enrollment Form
Complete a form for each new student that is enrolling.
Student's Name *
Your answer
Age *
Your answer
Date of Birth *
Your answer
School
Your answer
Grade (2018-19) *
Your answer
Student's Email Address
Your answer
Student's Cell Phone Number
Your answer
Parent or Guardian Names *
Your answer
Home Address *
Your answer
Parent Email Address *
Your answer
Parent Cell Phone Number *
Your answer
Parent Home Phone Number
Your answer
Emergency Contact Name/Number *
Your answer
Are there any personal circumstances of which I should be aware (special needs, health, allergies, etc.?) *
If you answered yes to the above question, please elaborate.
Your answer
I have read and agree to the terms of the current studio policy which can be found at www.anitaspianostudio.com *
Please check the boxes that apply to this student. *
Required
Type of piano you have at home *
Required
Technology available to student at home *
Required
How did you hear about my studio? *
Your answer
In order to best fit you in my schedule, please list days/times for lessons that you need.
Your answer
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