Child/Teen New Student Form

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Home
Classes
Tuition
News
- Past Recitals
- Practice Drawing Winners
Student Portal
Resources
About
- Meet the Teacher
- Tech in the studio
Contact

New Student Intake Form:
Child/Teen

New Student Form
Please fill out this form for me to keep in your student file.

* Indicates required field

Name of student *

First

Last

Age of student *

Student birthday month and day (so I can give a studio birthday present/play a birthday themed piano game that week) *

Name of parent/guardian *

First

Last

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Email *

Phone Number *

Name of other parent/guardian (if applicable) *

First

Last

Email of other parent/guardian (if applicable) *

Phone number of other parent/guardian (if applicable) *

Are you a local (ie. Middletown/Harrisburg, PA) or non-local student? *

Local Non-local

Time zone if non-local *

Eastern Central Mountain Pacific Other

What kind of instrument (piano, keyboard, or other) do you have at home? For acoustic piano, please put the maker's name and the last time it was tuned. For keyboard, please put the brand and the model. *

Availability for lessons (choose all that apply) *

Weekday mornings Weekday afternoons Weekday evenings Saturday

Does your child have access to an iPad at home? *

Yes No

Has your child taken lessons before? If so, when and for how long? What books were used? *

What are your goals for lessons? What kind of music or skills is your child interested in learning? *

How did you hear about the studio? *

Any additional questions, concerns or things you would like me to know? *

Submit

New Student Intake Form:Child/Teen

New Student FormPlease fill out this form for me to keep in your student file.

New Student Intake Form:
Child/Teen

New Student Form
Please fill out this form for me to keep in your student file.