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Student Enrollment Form
Welcome! Please help me keep your student's information up-to-date by completing the enrollment information below before the first lesson of each school year. I am looking forward to working with you!
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* Indicates required question
Student Name
*
Your answer
School Grade for 2022-2023 (enter N/A if not applicable)
*
Your answer
Age as of September 1, 2022
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Parent/Guardian Name(s) (enter N/A if over 18)
*
Your answer
Full Mailing Address with Zip Code
*
Your answer
Parent/Guardian Phone Number(s) (enter N/A if over 18)
*
Your answer
Parent/Guardian Email (enter na@na.com if over 18)
*
Your answer
Student Email (enter na@na.com if not applicable)
*
Your answer
Student Phone Number (enter N/A if not applicable)
*
Your answer
Emergency Contact Name and Phone Number
*
Your answer
Who should I contact via phone or email regarding scheduling, studio information, or payments?
*
Your answer
What email address should I use for lesson notes and assignments?
*
Your answer
Do you prefer monthly, semester, or annual tuition?
(Reminder: Tuition is non-refundable, so please plan to pay only for lessons you will use.)
*
Monthly (Due at first lesson of each month)
Semester (Due at first lesson in September and January)
Annual (Due at first lesson in September)
Do you or your child have any special learning or personal needs that I should be aware of in order to provide the most effective instruction?
*
Your answer
Does your child have any allergies or dietary restrictions?
*
Your answer
Do you or your child have special goals for piano study, such as dream pieces or accomplishments you want to work toward?
*
Your answer
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