Musical Moments Piano Studio - New Student Registration

Registration

WAITING LIST ONLY: Please take a moment to fill in the information below.

Are you an adult student or the parent of a student?

I am a(n)

Adult Student Information

First name *

Last name *

Email *

Website URL *

Phone *

Alternate Phone *

Birthday (example: mm/dd/yyyy) *

School *

Street

City

State/Province

Zip/Postal Code

Country

Login Details

Username *

Password *

Verify Password *

*You will not be able to login until your teacher has activated your account.

Parent Information

First name *

Last name *

Email *

Website URL *

Phone *

Alternate Phone *

Street

City

State/Province

Zip/Postal Code

Country

Login Details

Username *

Password *

Verify Password *

*You will not be able to login until your teacher has activated your account.

Student Information

First name *

Last name *

Phone

Birthday (example: mm/dd/yyyy) *

School *

Login Details

Username *

Password *

Verify Password *

Additional Information

INSTRUMENT: What type of piano will your child practice on? 1. Acoustic (Grand or vertical - see my blog for descriptions) 2. Digital Piano (Roland, Yamaha, other) 3. Portable Keyboard

SCHOOL/ACADEMIC 1. What school grade is this student in? 2. Are there any physical or learning issues that I should know to help me be a better teacher to your child?

EXTRA ACTIVITIES Please list all additional after school activities your child participates in (sports, dance, etc)

TRANSFERS ONLY 1. How much prior piano experience (lessons with another teacher) has this student had (in months/years)? 2. Name of previous teacher 3. If someone referred you to me, what is their name?

By checking the box and clicking 'Register" you agree to our studio policy.