Adult Student Information Form
This form is for students age 18 and up. Please submit this form to be considered for lessons.
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Name *
Age *
Date of Birth *
MM
/
DD
/
YYYY
Do you have digital access (iPad, laptop, etc.)? *
Do you have a musical background? *
Which best describes you? *
Why do you want to take piano lessons? *
Do you have regular access to a piano or keyboard? *
How long do you think you will be able to practice each week? *
Do you have any allergies or medical conditions that I should know about in case of emergency? (Your answer to this question is voluntary. Please only include important information I may need to know about - all information will be kept confidential)
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