Student Registration Form
Fill out the form carefully to join our waiting list
Student Name
*
First Name
Last Name
Date of birth of Student
*
-
Day
-
Month
Year
Date
Preferred pronoun
*
Please Select
he/him
she/her
they/them
Contact Name (parent/ carer if student is under 18 years)
First Name
Last Name
Contact email (parent/ carer if student is under 18 years)
*
example@example.com
Contact Number (parent/ carer if student is under 18 years)
*
-
Area Code
Phone Number
Address of Student
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School attended by Student
Student's current year group
Name of any other family members currently registered with Encore Music (if applicable)
I am interested in (tick all that apply):
*
Piano Lessons: Home Visits
Piano Lessons: Alderbrook School, Balham
Music Theory: group course online
Current piano ability of student
*
Beginner (no previous experience)
Early Learner (up to Grade 2 standard)
Improving Player (Grade 3-5 standard)
Experienced Performer (Grade 6 standard and above)
Returner (please state previous achievements below)
Previous musical experience
Please include name(s) of teacher(s), graded exams, recital/ festival experience and any other instruments, if applicable
Any other information you think we should know
I have read, understood and accepted the Privacy Notice
*
Yes
We would like to send you information about our services, by telephone, email and/or SMS. Please note that if you consent to being sent our information by email then your data will be shared with the third party organisation Mailchimp who will make contact on our behalf. If you agree to being contacted this way, please tick the relevant boxes:
Email
Phone
SMS
Submit
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