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Application for Lessons

Potential Students and their parents or legal guardians are asked to fill out the following form as directed.

Full Name of Potential Student:
Student's Age:
Full Name of Parent or Guardian filling out this form: (Or type Does not Apply for students over 18)
Full Name of Person I should contact regarding this form:
How would you like to be contacted regarding this application?
Daytime Phone Number:
Evening Phone Number:
E-mail address:(You must enter a valid address for the form to be submitted)
Does the student have any previous piano experience? If so, include the number of years and names of the method books the student has studied. (If not, enter No Previous Experience)

Does the student play any additional instruments? Has he/she shown interest in voice or dance? If so, briefly elaborate. (If not, enter No Other Instruments)

Is the student involved in any other activities during the week such as scouting, sports, clubs, choirs, bands or etc..? If so, briefly explain and/or state the days of the week and times of each activity. If not, enter No Other Activities.

Parents and Students should take into careful consideration other weekly activities the student is involved in when answering the next two questions.
The best day of the week for piano lessons is:
The best time of the day for piano lessons is:

The following question is to be completed by the Student.

In the space below, tell me why you are taking piano lessons:

The following questions are to be completed by the Parent or Guardian. (Choose Does not Apply if the student is 18 or older):

Which of the following best describes your child's attitude about piano lessons?
He/She is very resistant to the idea of taking piano lessons.
He/She is not happy about taking lessons now, but it will be good for him/her in the long run.
He/She is neither happy nor sad about lessons, but doesn't resist the idea.
He/She is very excited about taking lessons.
I'm not fully interested in my child taking piano lessons, but he/she is persistant about wanting to take lessons.
Does not Apply

In the space below, describe the goals and expectations you have for your child during his/her lesson experience. Also include any additional information you think I should know. Tell me why you want your child to take piano lessons. Please be specific. Type Does not apply if over 18

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