PIANO LESSON REGISTRATION FORM

School Year: 2026-2027

Student’s Full Name:

Date of Birth:

Age:

Grade:

Classroom/Homeroom Teacher:

Parent/Guardian Name:

Relationship to Student:

Phone Number:

Email:

Preferred Method of Communication:

Text Message Phone Call Email

Has your child taken piano lessons before?

Yes No

If yes, for how long?

Does the student have an instrument available for practice at home?

Acoustic Piano Digital Piano Keyboard No instrument currently available

Does your child study another musical instrument?

Is there anything in particular you would like your child to learn or accomplish through piano lessons?

Is there anything you would like me to know that would help provide your child with a safe, comfortable, and successful learning experience?

Registration