NewStudentInformationPleasef illo uttheinformationb elow:

StudentName:_________________________Birthday:_________________

School:__________________________________Grade:______________

SchoolDistrict:_________________

Parent(s)name(s):_____________________________________________________

Preferedmethodofcontact(circleone):home/cell/text/email/other:

____________________________________________________________________

HomePhone:____________________CellPhone:_____________________

Email:_______________________________________________________________

Students/ParentsMusicalBackground:______________________________________

_____________________________________________________________________

Typeofinstrument(s)athome:_______________________________(piano/keyboard)

Whatkindofmusicdoesthestudentlike?_____________________________________

Howdidyouhearaboutme?______________________________________________

CanIusepicturesorvideosofthestudentonmywebsite/blog/Facebookpage?

(Circleone):Yes/No/Maybe,askfirst

ParentName:_______________________________Date:_______________

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