Date

Parent Name

Address  City/State/Zip
Phone Fax
Email

Student Birthday Instrument
Student Birthday Instrument

1) How did you learn about MTC?
2) Is your child/children showing an interest in taking lessons? What are your goals for him/her?
3) Musical History.  Other instruments? Music classes in school?

4) Is their anything special about your child or family circumstances that you think may be helpful to understand in an effort to ensure your child's success?

5) Check box for days available for lessons and give a detailed time range after each day:
Monday Tuesday

Wednesday Thursday

Friday Saturday

IF STUDENT HAS STUDIED INSTRUMENT ALREADY, CONTINUE WITH THE FOLLOWING QUESTIONS:

6) Number of years studied

7) Kind of piano you currently own: Acoustic piano Digital piano Keyboard

8) Last method books/pieces studied