Student Information

Please be sure to scroll all the way down to complete all information. Thank you.

* Indicates required field

Student's Full Name *

Birthday *

School Attending *

Student's Email (if 12 or older) *

Student's Cell Phone (If 12 or older) *

Primary Parent's Name (First and Last) *

Primary Parent's Cell Phone *

Primary Parent's Email *

Primary Parent's Occupation *

Address (inc. city, state, zip) *

Home Phone Number (If applicable) *

Secondary Parent's Name (First and Last) *

Secondary Parent's Cell Phone *

Secondary Parent's Email *

Secondary Parent's Occupation *

Years of Piano Instruction *

Suzuki Book Level: Select One *

Does Family Have a good acoustic (non-electric) piano that is well-tuned and maintained? Choose One *

Yes No Need guidance

Will Family encourage and support music listening as follows: Select One *

Will Family support daily practice (minimum of 6 days per week)? *

YES

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