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Private Piano Lesson Registration 2020-2021
Thank you for taking the time to fill out the registration form! Please let me know if you have any questions!
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* Indicates required question
Parent or Guardian Name
*
Your answer
Student Name
*
Your answer
Date of Birth
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MM
/
DD
/
YYYY
Address
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Your answer
Phone number
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Your answer
Email address
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Your answer
Emergency contact name and phone number (if other than parent/guardian)
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Your answer
Does the student have allergies (for studio events)? If so, list below!
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Your answer
Do you have a piano at home?
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Yes
No
If so, what kind? All three options are great!
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Grand Piano
Upright Piano
Keyboard
Other:
Does the student have any experience with music (any instrument)?
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Your answer
Do you agree to the studio policy?
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Yes
No
Photo permission? (The picture would not be shared on social media)
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Yes
No
How did you hear about the Piano Studio of Hannah Pirc?
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Your answer
Any questions, comments, or concerns?
Your answer
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