Child Student Registration Form

Child and Teen Student Questionnaire

Fill out the form carefully for registration
Name*

First NameLast Name
Nickname
Birth Date*

MonthDayYear
Lesson Length?
Grade in School
School Name and Neighborhood
Gender
What are your other extra-curricular activities, interests and hobbies?
Why do you want to learn to play the piano? Any specific goals?*
What are your thoughts about performing in school talent shows, in recitals or competing?*
YesNo
Do you have any other friends who play piano?
YesNo
What times in the day and week do you think you can dedicate to practicing?
Do you understand the studio policies and promise to be prepared for lessons?
Will you be willing to participate in all studio events, festivals, theory exams and requirements?
Are there any questions you have for me, as your piano teacher?
Student Signature*

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Name

First NameLast Name
Parent/Guardian Information

(for Parent of Student to complete)
Parent/Guardian #1 Name*

First NameLast Name
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #1 Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #1 Email*
example@example.com
Parent/Guardian #2 Email
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If your child is being cared for on a regular basis by someone other than the parent, please provide the name and cell number of the person:
How did you hear about Music with Monique? (Name of referral)
Do you have any other children (ages, names)?
Does anyone in the family play piano or other musical instruments?
What are your goals for your child as a piano student?
Are you interested in your child’s participation in performance opportunities and competitions?
Does your child have any learning challenges, or difficulty focusing or paying attention? Any other behavioral issues discovered in school?
What kind of piano do you have?
If acoustic, do you have a regular tuner?
YesNoLet's discuss how best to make this happen
YesNo
How do you plan on supporting your child with their musical education?
What expectations do you have of me as a piano teacher?
Any food or other allergens I should be aware of?
Any other thoughts/questions/comments?

Important School Dates and Holidays:*

Rows	Date(s)
First day of school
Fall Break(s)
Thanksgiving Break
Winter Break
First day of school January
Spring Break(s)
Other known days off from school
Known extended trip/vacation dates

Your signature below indicates that you have read and understand the teaching policies of my studio and that all information provided is accurate and comprehensive:*

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Signature of Parent/Guardian
Name of Parent/Guardian*

First NameLast Name
Date

YearMonthDay
Date
Country of Residence*
PHOTOGRAPH AND VIDEO AUTHORIZATION FORM
In the Music with Monique/ Musique mit Monique Studio, we enjoy celebrating our students’ musical progress and special moments throughout the year.

During private lessons, short video or audio recordings may occasionally be made for educational purposes. Students will always be informed when a photograph or short recording is being made.These recordings are used almost exclusively to share progress updates directly with parents or guardians.

From time to time, photos or short video clips may also be taken during lessons, recitals, group classes, or online sessions to:
- Celebrate student achievements
- Share highlights with studio families
- Feature performance excerpts on our website or social media
We will never publish sensitive personal information (such as full names, addresses, or school names). When celebrating a specific student's achievements, we will confirm permission before even sharing their first name. Participation is completely optional.

You may update or withdraw your consent at any time in writing, with future effect.
Yes: I give permission for public sharing (website, social media, and print advertising)Yes: but for private studio use only (only lesson recordings for parents and studio newsletterNo: please do not photograph or record my child
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.
Full Name of Parent/Guardian*

First NameLast Name
Electronic Signature*

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By signing above, I confirm that I am the legal parent or guardian of the student listed and have authority to provide this consent.
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.
Full Name of Parent/Guardian*

First NameLast Name
Signature of Parent or Guardian of Student*

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Child and Teen Student Questionnaire

Parent/Guardian Information

PHOTOGRAPH AND VIDEO AUTHORIZATION FORM

DATA AUTHORIZATION - USA Students

DATA AUTHORIZATION - EUROPE Students