Child/Teen New Student Form

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New Student Intake Form:
Child/Teen

* Indicates required field

Name of student *

First

Last

Age of student *

Student birthday month/day/year (so I can plan a special birthday-themed lesson the week of their birthday) *

Name of parent/guardian *

First

Last

[object Object]

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 do you have at home? *

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 or comments for the teacher? *

Submit

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