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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 _________________________________________
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
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