REGISTRATION FORM

Student Information

Name

First Name

Last Name

Current Age

Date of Birth

YYYY

Grade in School

Name of School

Currently doing school

Student Email

Student Cell Phone

(###)

###

####

Okay to text this number?

List after-school/extracurricular activities

How often do these activities meet?

List other instruments played

List names & ages of siblings

Are there any health concerns the teacher should be aware of in order to provide the optimal learning environment and appropriate instructional strategies for your child?

Parent Information

Parent Name (Studio Parent)

First Name

Last Name

Parent Name (Spouse/Partner)

First Name

Last Name

Physical Address

Mailing Address (if different than physical address)

Main Email Address for Studio Communication

Studio Parent Contact Phone

(###)

###

####

Okay to text this number?

Spouse/Partner Contact Phone

(###)

###

####

Okay to text this number?

Piano Information

Make of Piano (name on front) and Model # (if known)

Type of Piano

Age of Piano

Is your piano in good repair with all the keys and pedals working properly?

Date piano was last tuned

Name of piano tuner

Home Practice Environment

List the places you have set up for your child to hear the Suzuki recording throughout the day:

What time(s) have you scheduled into your day for daily practice?

Where in your home is the piano located?

During practice time will this location be free of distractions (TV, computer, siblings, pets, toys, etc.)?

Is there adequate lighting for reading music and lesson notes during practice?

Is there a designated place near the piano for piano books and practice supplies?

Please describe your system for making sure piano books make it to lesson each week:

Emergency Contact Information

Contact person in case of medical emergency

Emergency Contact Phone

(###)

###

####

What is this person's relationship to the student?

REGISTRATION FORM

Student Information

Parent Information

Piano Information

Home Practice Environment

Emergency Contact Information

Preferred Tuition Payment Method