Student Information

Student's First Name:   Last Name: Age:

MaleFemale    Check Box if Student is Beginner:     If not how long has the student been playing:

 years, months  Instrument:

Preferred Teacher (refer to Faculty page):   Number of Siblings students at School:

Please Describe Briefly what music/scales/etc. the student has been working on:

Parents Information

Father's First Name: Last Name:

Mother's First Name: Last Name:

Father's Home Phone: , Work Phone: , Cell Phone:

Mother's Home Phone: , Work Phone: , Cell Phone:

Father's Address:                                       

Mother's Address (if different than Father's):

Availability

Please list best day and time for weekly lesson:

Any additional Comments: