StudentName:_________________________Birthday:_________________
School:__________________________________Grade:______________
SchoolDistrict:_________________
Parent(s)name(s):_____________________________________________________
Preferedmethodofcontact(circleone):home/cell/text/email/other:
____________________________________________________________________
HomePhone:____________________CellPhone:_____________________
Email:_______________________________________________________________
Students/ParentsMusicalBackground:______________________________________
_____________________________________________________________________
Typeofinstrument(s)athome:_______________________________(piano/keyboard)
Whatkindofmusicdoesthestudentlike?_____________________________________
Howdidyouhearaboutme?______________________________________________
CanIusepicturesorvideosofthestudentonmywebsite/blog/Facebookpage?
(Circleone):Yes/No/Maybe,askfirst
ParentName:_______________________________Date:_______________
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