JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Lighthouse School of Music Student Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Best phone number to reach you?
*
Your answer
Age
*
Your answer
Gender
*
Male
Female
Purpose for wanting to learn to play by ear?
*
Life long dream
Church Musician
In a band
Therapeutic
Professional Singer
Recreational
Other:
Required
What type of lessons have you taken in the past?
*
Voice
Drums
Saxophone
Guitar
Piano
None
Other:
Required
What type of Piano will you be practicing with?
(Electric or Acoustic / Brand Name)
*
Your answer
Can any other family members play?
*
Yes
No
How many years have you invested in playing so far?
*
Just starting
1 - 6 months
1 year
2 years
3 years
4 years
5 years
More than 5 years
How long are you giving yourself to see results?
*
6 months
9 months
1 year
2 years
3 years +
What major issue would you like me to help you with in your piano lesson?
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
