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.
Date of Birth
Student Phone Number (if available)
Student Email address (if available)
Grade (in 2017-18)
Does your student have digital access (iPad, laptop, etc.)?
Under Time Limits
Do you have a musical background?
Which best describes you?
I have never taken piano lessons before and am excited to start learning.
I took lessons in the past, but have been out of practice for at least a year.
I have taken piano lessons for a least a year with no break but with a different teacher.
I have a particular song or style I would like to learn, and that's it.
A parent or family member has talked me into taking lessons and I have mixed feelings about it.
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? (Response to this question is voluntary. Please only include important information I may need to know about - all information will be kept confidential)
Do you have any questions or anything to add?
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