Online Registration

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Student Information

Student Name*

Birthdate*

Age*

Grade*

Contact Information

Parent/Guardian Names*

Home Phone

Cell

Other Phone

Email*

Mailing Address*

City*

Postal Code*

Please answer the following questions pertaining to the student:

What is the main reason or goal for wanting to take piano lessons?

Tell me a bit about the student. (ie. personality, learning style, hobbies etc.)

Are there any behavioral/learning anomalies you would like me to be aware of?

Does the student have any allergies/medical conditions you would like me to be aware of?

Lesson Scheduling - Please specify what days and times works best for you. I will do my best to accommodate all requests, I can not guarantee that you will be given a spot in your top 3 selections.