STUDENT REGISTRATION
Student Name: _____________________________________ Birthdate: ___/___/______
Parent/Guardian Name: ______________________________________________________
Parent Email Address: ______________________________________________________
Phone: _________________________________ Can receive texts? ______
Home Address: _______________________________________________________________
(2nd Parent/Guardian Name:_______________________________________________________
Phone:_________________________ Can receive texts? _____
Email Address: _________________________ )
Student Phone: __________________
Student Email Address: ___________________
Emergency Contact Name & Number: ____________________________________________
Has your child had piano lessons before? If yes, what is the length of study and what music books is your child using? ______________
Where did you hear about this studio?___________________________
Additional Comments/ Describe your availability during the school year ________________________________________________________________________________
_________________________________________________________________________________
Any allergies/medical concerns or other comments?
__________________________________
Adult student registration-
Student Name: _____________________________________
Email Address: ______________________________________________________
Phone: _________________________________ Can receive texts? ______
Home Address: _______________________________________________________________
Emergency Contact Name & Number: _____________________
Has your child had piano lessons before? If yes, what is the length of study and what music books is your child using? ______________
Where did you hear about this studio?___________________________
Additional Comments/ / Describe your availability during the school year ________________________________________________________________________________
_____________________________________________
Allergies/ Medical or other concerns?