Student Name *

First Name

Last Name

Parent Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

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Has this Student taken piano lessons previously? *

No experience

Up to 6 months

6 months-1 year

1-2 years

More than 3 years

Do you own a piano/keyboard at home? *

Piano

Keyboard (weighted: hammer action)

Keyboard (non-weighted)

We don't have piano or keyboard at home

Your child's personality: please check all the boxes that apply.

ambitious

cheerful

easy-going

funny

open-minded

optimistic

reserved

shy

confident

insecure

patient

Your child's learning style: please check the strongest two

visual

auditory

read/write

kinesthetic