New Student Registration Form (Adult)
If you are an adult student, please fill out the form below.  Answer questions with as much detail as you can provide.  
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First Name *
Last Name *
Birth Date *
Address *
Telephone Number *
This is my *
E-mail *
Other
Emergency Contact Name *
Relation *
Telephone Number *
Please pick what most closely describes your learning and work habits. *
Number of hours you watch TV each day *
Number of hours you use the computer each day *
Please list any special interests and hobbies you have. *
What instruments, if any, do other family members play? *
Does the family participate in other musical activities? *
If yes, please list below.
If you have had any previous musical instruction, please describe it. *
Describe your interest in music and the piano. *
How long will you be able to practice each day? *
Do you have a piano? *
Type? *
Brand
What is the condition of your piano? *
Do you own a metronome? *
Why do you want to take piano lessons? *
What do you expect from me as a teacher? *
*
Required
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