Talley Piano Studio
STUDENT NAME________________________________________________________________________________________BIRTHDATE____________________________________________________________
PARENT OR GUARDIAN NAME_______________________________________________________________________________________________________________________________________________
ADDRESS ______________________________________________________________________________________________________________________________________________________________________________________________
CITY_________________________________________________________________STATE_______________________________________________________________ZIP CODE_____________
PRIMARY PHONE_________________________________________________________________________CELL PHONE_______________________________________________________________________
EMAIL ADDRESS______________________________________________________________________________________________________________________________________________________________________________
PIANO OR MUSIC EXPERIENCE______YES__________NO_______ IF SO WHAT KIND___________________________________________________________
DO YOU OWN A PIANO OR KEYBOARD______YES___________NO_______________
DOES YOUR CHILD HAVE ALLERGIES______________________________________________________________________________________________________________________________
EMERGENCY CONTACT NUMBER_______________________________________________________________________________________________________________________________________
LESSON LENGTH - THIRTY MINUTES_________FORTY FIVE MINUTES__________SIXTY MINUTES_______________________
PLEASE COMPLETE THE ENROLLMENT FORM AND EMAIL TO THE STUDIO AT [email protected] or [email protected]. AS SOON AS IT IS RECEIVED THE STUDIO WILL CONTACT YOU TO ARRANGE A LESSON DAY AND TIME.
THANK YOU FOR CONSIDERING US FOR YOUR CHILD'S PIANO EDUCATION
PLEASE PRINT
STUDENT NAME________________________________________________________________________________________BIRTHDATE____________________________________________________________
PARENT OR GUARDIAN NAME_______________________________________________________________________________________________________________________________________________
ADDRESS ______________________________________________________________________________________________________________________________________________________________________________________________
CITY_________________________________________________________________STATE_______________________________________________________________ZIP CODE_____________
PRIMARY PHONE_________________________________________________________________________CELL PHONE_______________________________________________________________________
EMAIL ADDRESS______________________________________________________________________________________________________________________________________________________________________________
PIANO OR MUSIC EXPERIENCE______YES__________NO_______ IF SO WHAT KIND___________________________________________________________
DO YOU OWN A PIANO OR KEYBOARD______YES___________NO_______________
DOES YOUR CHILD HAVE ALLERGIES______________________________________________________________________________________________________________________________
EMERGENCY CONTACT NUMBER_______________________________________________________________________________________________________________________________________
LESSON LENGTH - THIRTY MINUTES_________FORTY FIVE MINUTES__________SIXTY MINUTES_______________________
PLEASE COMPLETE THE ENROLLMENT FORM AND EMAIL TO THE STUDIO AT [email protected] or [email protected]. AS SOON AS IT IS RECEIVED THE STUDIO WILL CONTACT YOU TO ARRANGE A LESSON DAY AND TIME.
THANK YOU FOR CONSIDERING US FOR YOUR CHILD'S PIANO EDUCATION
PLEASE PRINT