School-age Student Information Form
This form is for school aged children (age 6-18). Please answer section 1 from the student's perspective. Section 2 will cover family information.
Student Name *
Your answer
Age *
Date of Birth *
MM
/
DD
/
YYYY
Student Phone Number (if available)
Your answer
Student Email address (if available)
Your answer
School *
Your answer
Grade (in 2017-18) *
Does your student have digital access (iPad, laptop, etc.)? *
Do you have a musical background? *
Which best describes you? *
Why do you want to take piano lessons? *
Your answer
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? (Response to this question is voluntary. Please only include important information I may need to know about - all information will be kept confidential)
Your answer
Do you have any questions or anything to add?
Your answer
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