New Student Information
Name: ____________________________________________________ Age: ____________________
Address____________________________________________________
_____________________________________________________________
Parents’ names:
_____________________________________________________________ _______________________________________________________
Email address(es):
______________________________________________________________ _______________________________________________________
Phone:
(Indicate “home”, “cell”, or “work” and whose # it is)
_______________________________________________________________ ______________________________________________________
_______________________________________________________________ ______________________________________________________
Date of 1st lesson with me: _____________________________
Any previous piano lessons? __________________________ If yes, how long? __________________________________
Why did you stop?
____________________________________________________________________________________________________________________________
How did you hear about me?
____________________________________________________________________________________________________________________________
What type of keyboard do you have? Electric _______________________ Regular piano _____________________
Name: ____________________________________________________ Age: ____________________
Address____________________________________________________
_____________________________________________________________
Parents’ names:
_____________________________________________________________ _______________________________________________________
Email address(es):
______________________________________________________________ _______________________________________________________
Phone:
(Indicate “home”, “cell”, or “work” and whose # it is)
_______________________________________________________________ ______________________________________________________
_______________________________________________________________ ______________________________________________________
Date of 1st lesson with me: _____________________________
Any previous piano lessons? __________________________ If yes, how long? __________________________________
Why did you stop?
____________________________________________________________________________________________________________________________
How did you hear about me?
____________________________________________________________________________________________________________________________
What type of keyboard do you have? Electric _______________________ Regular piano _____________________