Child Student Registration

Parent First Name*

Parent Last Name*

Email*

Mobile*

Format: 0000000000.

Home Phone

Format: 00 0000 0000.

Check here if you'd like to add another parent contact for billing or lesson reminders

Second Parent First Name

Second Parent Last Name

Second Parent Email

Second Parent Mobile

Format: 0000000000.

Should this parent receive invoices and / or lesson reminders?

Student First Name*

Student Last Name*

Parent Full Name

Second Parent Full Name

Student Full Name

Student Age

Phone Number

Please enter a valid phone number.Format: +61000000000.

Please briefly describe {studentFirst}'s musical background, including any previous training in piano, other instruments, or voice.

Phone to pass to Monday

Check to register a second child for piano lessons

Student First Name

Student Last Name

Student Age

Please briefly describe {SecondstudentFirst79}'s musical background, including any previous training in piano, other instruments, or voice

Check to register a third child for piano lessons

Student First Name

Student Last Name

Student Age

Please briefly describe {ThirdstudentFirst84}'s musical background, including any previous training in piano, other instruments, or voice

Would you like to attend lessons at the teacher's home studio or at your home?

Teacher StudioMy homeEither

Address

Street Address

Street Address Line 2

Suburb

Post Code

Preferred Teacher / Location

If you have a specific teacher or studio location in mind, please let us know. Otherwise please let us know the suburb where you live or work and we will advise the closest teacher.

Preferred Teacher

If you have a specific teacher in mind, please let us know.

Do you have a piano or keyboard at home?

Would you like your child to take AMEB exams?

YesNoMaybe

What is your child's current grade level in AMEB Piano

Preferred days / times for lessons

How did you hear about Adelaide Academy of Piano?

Other - please specify

Who referred you?

Any specific interest or focus for the lessons? (Click as many as apply)

What are you interested TO PASS TO MONDAY

Anything else you'd like to share

Subscribe to our e-newsletter?

Yes, I'd like to receive it

Pref Teacher

Child Student Registration Form