Studio Registration Form
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Student Information
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade in School (entering in August)
School Name
Experience Level
*
Never had a lesson
Basic knowledge of music
Proficient, but would like to learn more advanced pieces
Please choose lesson type:
*
Piano
Voice
What are your musical goals for your child?
Is there anything else I should know about your child that would help me serve their needs better?
Do you have any other children to register?
*
Yes
No
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Student #2
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade in School (entering in August)
*
School Name
*
Experience Level
*
Never had a lesson
Basic knowledge of music
Proficient, but would like to learn more advanced pieces
Please choose lesson type:
*
Piano
Voice
What are your musical goals for your child?
Is there anything else I should know about your child that would help me serve their needs better?
Do you have any other children to register?
*
Yes
No
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Student #3
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade in School (entering in August)
*
School Name
*
Experience Level
*
Never had a lesson
Basic knowledge of music
Proficient, but would like to learn more advanced pieces
Please choose lesson type:
*
Piano
Voice
What are your musical goals for your child?
Is there anything else I should know about your child that would help me serve their needs better?
Do you have any other children to register?
*
Yes
No
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Student #4
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade in School (entering in August)
*
School Name
*
Experience Level
*
Never had a lesson
Basic knowledge of music
Proficient, but would like to learn more advanced pieces
Please choose lesson type:
*
Piano
Voice
What are your musical goals for your child?
Is there anything else I should know about your child that would help me serve their needs better?
Do you have any other children to register?
*
Yes
No
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Next
Student #5
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade in School (entering in August)
*
School Name
*
Experience Level
*
Never had a lesson
Basic knowledge of music
Proficient, but would like to learn more advanced pieces
Please choose lesson type:
*
Piano
Voice
What are your musical goals for your child?
Is there anything else I should know about your child that would help me serve their needs better?
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Contact Information
Parent/Guardian Information
*
Name
Relationship to Student(s)
Address
*
Street Address
City
Zip Code
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Preferred Method of Contact
*
Text
Call
Email
Do you have a piano or keyboard in your home?
*
Piano
Electronic Keyboard
No (If this is the case, please talk to me about how your child will be practicing.)
Online Media-Please choose an option below:
*
I do not want my child's name included in online posts
You may include my child's name in online posts.
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Schedule Availability
Please mark all days and times when you are NOT available for lessons. This helps me build a schedule that avoids conflicts.
Please select times on MONDAY that DO NOT work for you:
*
I am NOT available at all on Mondays
9:00AM - 1:30PM
3:30PM -4:00PM
4:00PM - 4:30PM
4:30PM - 5:00PM
5:00PM - 5:30PM
5:30PM - 6:00PM
Please select times on TUESDAY that DO NOT work for you:
*
I am NOT available at all on Tuesdays
10:00AM - 1:30PM
3:30PM -4:00PM
4:00PM - 4:30PM
4:30PM - 5:00PM
5:00PM - 5:30PM
Please select times on WEDNESDAY that DO NOT work for you:
*
I am NOT available at all on Wednesdays
9:00AM - 1:30PM
3:30PM -4:00PM
4:00PM - 4:30PM
4:30PM - 5:00PM
5:00PM - 5:30PM
5:30PM - 6:00PM
Please select times on THURSDAY that DO NOT work for you:
*
I am NOT available at all on Thursdays
9:00AM - 10:00AM
10:00AM - 11:00AM
11:00AM - 12:00PM
12:00PM - 1:00PM
Please select times on FRIDAY that DO NOT work for you:
*
I am NOT available at all on Fridays
9:00AM - 10:00AM
10:00AM - 11:00AM
11:00AM - 12:00PM
12:00PM - 1:00PM
What is your IDEAL lesson day/time?
(I will do my best to accommodate your preference!)
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Studio Policy
Please take a moment to read through the attached studio policy. These guidelines help ensure a smooth and positive experience for all students. You are welcome to download and keep a copy for your records. By signing below, you confirm that you have read and agree to the policies and are registering for lessons in the studio.
My signature below indicates that I have read the studio policy and agree to the terms. By submitting this form, I am enrolling my child as a student at Keys and Cords Music Studio with Jamie Taylor.
*
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