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Student Information
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Student Name (first and last)
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Birthday
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School & Grade
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Best Phone Number
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Address, city, state, zip
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Parents Name(s)
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Referred by:
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Email Address
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Please tell us a little bit about this student (i.e. personality, learning style, etc.) so we can choose a
teacher that would be a good fit for your child.
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Musical Background
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Adult Student
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New Student
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Transfer Student
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Beginning Year of lessons
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Previous Studio/Teacher
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Current Level
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Reason for switching studio/teacher
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Books used
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Check all that apply:
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The student wants lessons
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The parent wants lessons for the child
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All of our children are required to take music lessons
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Mom or dad has musical knowledge. Please explain:
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Instrument Information
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For Piano Lessons: our instrument requirements are as follows: You must have a working, tuned acoustic
piano OR an electronic keyboard with 1) Full keyboard (88 keys); 2) Touch-sensitive keys (when you press
harder, the sound is louder); 3) Sustain pedal (the notes ring out when the pedal is down). We will not
begin piano lessons without one of these instruments. Please contact us if you need help obtaining a
piano! We can help!
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Yes! We fulfill these requirements!
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No, but we are working on it! Explain:
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I am enrolling for Guitar Lessons
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Piano
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Keyboard
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Year made:
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Year made:
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Brand:
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Brand:
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upright
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grand
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spinet
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88 keys?
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yes
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no
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Tuned every 6 months?
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yes
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no
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Pedal?
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yes
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no
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Weighted?
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yes
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no
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Practice Requirements
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We require students to commit to 6 days of practice a week, generally 15-30 minutes per day.
Our teachers use FUN, creative incentives to help students do the best they can!
Can this student commit to this? Explain.
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no
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yes
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