KAY COLLINS
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STUDENT INFORMATION FORM

Please download this file, fill in appropriate information
and bring to interview.
piano_student_registration_form.doc
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PIANO STUDENT - ​REGISTRATION INFORMATION

DATE                  _________________________________________    
             
​STUDENT NAME   _______________________________________________________________________________________________________________________
 
ADDRESS        _____________________________________________________________________________________________________________________________
 
                               _____________________________________________________________________________________________________________________________
 
CONTACT (Parents See Below):  HOME PHONE   _________________________________  CELL PHONE _____________________________________
          
EMAIL   (For Piano Information):­­ ­­­­­­­­­­­­_________________________________________________________________________________________________________

EMERGENCY CONTACT:_______________________________________________________________________________________________________________
 
FAMILY NAMES AND CONTACTS
      Mother/Spouse_________________________________________________        Father/Spouse__________________________________________________
     
​      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  ______________________________________________________________________________________________________________________
 
SPECIAL NEEDS OR CONSIDERATIONS (How to Handle)   ____________________________________________________________________________
 
 ____________________________________________________________________________________________________________________________________________

​REFERRAL FROM 
(circle one):       Friend ___________________________________________________________________________
​                                                                          Website                   Thumbtack.com                       Lessons.com

​POLICIES AND PROCEDURES:   Received                  Read              Signed and Turned into Studio

Lesson Information

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Member of Music Teachers Associations

Music Teacher National Association
Fort Collins Music Teachers Association
Colorado State Music Teacher Association

Kay Collins
Piano Lessons        
​Fort Collins, Colorado

  • Home Page
  • Lessons
    • Lesson Types
    • Lesson Content and Benefits
    • Lesson Duration and Fees
    • Lesson Information
  • Student Information Form
  • Testimonials
  • About Kay Collins
  • Contact