New Student Enrollment                                        Today’s  Date___________________


Name__________________________________________Phone___________________________

Address__________________________________________________________________________

School________________________________________________Current Grade___________

Birthdate _____________________________________________email___________________

Have you ever taken piano lessons before?_______When?_____________________________

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Do you play any other musical instruments? Formal lessons?

How  long?______________________________________________________________________


What kind of piano do you have at home?    (circle)   GRAND     UPRIGHT

How many pedals does it have? _______________


What other musical equipment/ instruments do you have at home? (metronome? recorder?
 
electric keyboard? recording equipment? clarinets, violins, etc.)  _______________________________

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Of the people who live with you, who else plays the piano? A little? A lot? _______________________

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What else should I know about you and your interest in music? _______________________________________________________________________________________

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