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Please download this file, fill in appropriate information
and bring to interview. |
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PIANO STUDENT
REGISTRATION INFORMATION
DATE _________________________________________
NAME _____________________________________________________________________________________________________________________________
ADDRESS _____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
HOME PHONE _______________________________________________ CELL PHONE ______________________________________________________
EMAIL ___________________________________________________________________________________________________________________________________
FAMILY NAMES AND CONTACTS
Mother ______________________________________________________ Father ______________________________________________________________
Cell Phone __________________________________________________ Cell Phone _________________________________________________________
Brothers/Sisters ________________________________________________________________________________________
STUDENT
Age/Birthday _______________________________________________ School/Grade _____________________________________________________
Starting Date _______________________________________________ Lesson Time _____________________________________________________
Lesson Fee ______________________________________________ (per visit)
LESSONS
Level of Play __________________________________________________________________________________________________________________________
Purpose of Lesson ____________________________________________________________________________________________________________________
Area to work on ______________________________________________________________________________________________________________________
COMMENTS ___________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
REFERRAL FROM (circle one): Friend ___________________________________________________________________________
Website Thumbtack Newsletter Flyer
POLICIES AND PROCEDURES: Received Read Signed and Turned into Studio
NAME _____________________________________________________________________________________________________________________________
ADDRESS _____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
HOME PHONE _______________________________________________ CELL PHONE ______________________________________________________
EMAIL ___________________________________________________________________________________________________________________________________
FAMILY NAMES AND CONTACTS
Mother ______________________________________________________ Father ______________________________________________________________
Cell Phone __________________________________________________ Cell Phone _________________________________________________________
Brothers/Sisters ________________________________________________________________________________________
STUDENT
Age/Birthday _______________________________________________ School/Grade _____________________________________________________
Starting Date _______________________________________________ Lesson Time _____________________________________________________
Lesson Fee ______________________________________________ (per visit)
LESSONS
Level of Play __________________________________________________________________________________________________________________________
Purpose of Lesson ____________________________________________________________________________________________________________________
Area to work on ______________________________________________________________________________________________________________________
COMMENTS ___________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
REFERRAL FROM (circle one): Friend ___________________________________________________________________________
Website Thumbtack Newsletter Flyer
POLICIES AND PROCEDURES: Received Read Signed and Turned into Studio
