Adult Student Registration Form

Adult Student Questionnaire

Fill out the form carefully for registration
Name*

First NameLast Name
What type of lessons are you interested in?*
Phone Number*

Country CodeArea CodePhone Number
E-mail*
example@example.com
Birth Date*

MonthDayYear
Gender Identity
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Why do you want to learn to play the piano? Any specific goals?
What are your other interests and hobbies?
Field of Work / Educational Background
YesNo
If Yes, What did you like / not like about studying with your former teachers?
TheoryTechniqueRhythm / Counting / MetronomeEar TrainingSight-readingFingeringPhrasingImprovisingComposingMemorizing
If Yes, What was the highest level of performance you achieved (if you used method books) or what pieces are you most proud of learning?
Which foundation areas would you like to have more experience studying?
What are your thoughts about performing in recitals or in front of friends?
YesNoOther
What do you perceive being your biggest obstacles for practice?
How do you plan to overcome these obstacles?
Are there any questions you have for me, as your new piano teacher?
How did you hear about Music with Monique? (Name of referral)
Do you have any learning difficulties I should be made aware of?
What kind of piano do you have?
If acoustic, do you have a regular tuner?
Is your piano in a space that is quiet, well lit, free of distractions?
What expectations do you have of me as a piano teacher?
Your signature below indicates that you have read and understand the teaching policies (link) of the Music with Monique studio and that all information provided is accurate and comprehensive. *

Clear
Name*

First NameLast Name
Date*

YearMonthDay
Date
Country of Residence*
PHOTOGRAPH AND VIDEO AUTHORIZATION
For educational purposes and to celebrate students' and the studio's events, Music with Monique/Musique mit Monique studio may occasionally photograph or record lessons, recitals, group classes, or online sessions. This is always done with notice.

Recordings made during private lessons are only used for educational purposes and may be shared directly with you for practice review and progress tracking. You will always be informed if a photograph is being taken or a short recording is being made.

Photos or short clips or group classes and recitals may also be used for:
- Studio website or social media
- Studio newsletters
- Promotional materials
No sensitive personal information will be published without additional consent. When celebrating student's achievements, only first names are ever used.

Participation is voluntary, and you may withdraw consent in writing at any time with future effect.
Yes: I give permission for public sharing (website, social media, print advertising)Yes: I give permission for internal studio use only (such as recording of my own lesson and internal studio newsletters).No: I do not authorize photography or recording.
Germany / EU GDPR Notice

Media is processed based on your consent under Art. 6(1)(a) GDPR.

You have the right to access, correct, or request deletion of your data and may withdraw consent at any time with future effect.
I acknowledge the GDPR notice above
Name*

First NameLast Name
Student Signature*

Clear
Today's Date

YearMonthDay
Date
DATA AUTHORIZATION - USA Students

I understand that Music With Monique, LLC will collect my name, contact information, lesson records, and payment information for the purposes of organizing, teaching, and billing piano lessons. This information will be kept secure and will not be shared with third parties except as needed to process payments or comply with the law.
DATA AUTHORIZATION - EUROPE Students

I agree that Music With Monique/Musique mit Monique 10405 Berlin may process my personal data (name, contact details, lesson records, and payment data) for the purpose of organizing, delivering, and billing piano lessons, and for required bookkeeping. Data will be stored only as long as required by law and for the management of the studio and will not be shared with third parties except where legally required (e.g. tax authorities or payment providers). I can request access, correction, or deletion of my data within the framework of the GDPR at any time, as far as no statutory retention duties apply.
Name*

First NameLast Name
Student Signature

Clear
Today's Date

YearMonthDay
Date
Should be Empty:

Adult Student Questionnaire

PHOTOGRAPH AND VIDEO AUTHORIZATION

DATA AUTHORIZATION - USA Students

DATA AUTHORIZATION - EUROPE Students