Student Type *

Child

Adult

Parent Name *

If student is an adult, enter own name.

First Name

Last Name

Student Name *

First Name

Last Name

Parent Phone *

If student is an adult, enter own phone number.

(###)

###

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Skill Level

Beginning

Intermediate

Advanced

Student Birthdate

MM

DD

YYYY

What kind of instrument will the student have access to for practicing? *

Upright Piano

Grand Piano

Digital keyboard with 88 fully-weighted keys

Digital keyboard with unweighted keys

Are you prepared to make attendance at piano lessons and regular practicing a priority? *

Yes

No

Unsure

Have you read the studio policy, and do you agree to abide by it? *

Yes

No