Student Application
Student's Name *
Birthday *
DD/MM/YY
Current School Grade
(if applicable)
Lesson Length Desired *
Student’s Practice Instrument: *
Has s/he previously taken any piano lessons? *
If you answered "yes" to the above question, please list the piano books the student currently owns and indicate which books s/he has most recently been working from.
Has s/he previously taken lessons for any other musical instrument (guitar, violin, flute, etc.)? *
Do you have any long-term goals in taking piano lessons?
How did you hear about Charlotte’s Piano Studio? *
Parent/Guardian Name
(if student is under age 18)
Hometown *
Contact Number *
Email *
Preferred method of contact: *
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