2017-2018 Student Registration Form

STUDENT INFORMATION

Are there special circumstances of which the teacher should be aware (allergies, special needs, health problems, learning disabilities, etc.)?



Are there special circumstances of which the teacher should be aware (allergies, special needs, health problems, learning disabilities, etc.)?



Are there special circumstances of which the teacher should be aware (allergies, special needs, health problems, learning disabilities, etc.)?



FAMILY INFORMATION

OTHER INFORMATION

Are there religious beliefs or other circumstances that might impact repertoire choices or performance dates or performance venue?



Permission is given for each students' photo to be used for the studio website and Facebook purposes.



Please include my name and contact information on the swap list for Extended Absences.



I have read, understand and agree to abide by the terms of the Piano Studio Policy.



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