General Application
Basic Information
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Student's Name:
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Birth date:
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Parents' Names:
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Email address:
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Street Address:
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Home phone:
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Cell phone:
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How did you hear about us?
Musical Information
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Instrument:
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Has this student played the instrument before?
Yes
No
If yes, where?
How long has the student played?
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Has the student taken private music lessons before?
Yes
No
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Can the student read music?
Yes
No
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Has the student taken music theory?
Yes
No
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How did the student first become interested in this instrument?
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Does the student have any learning disabilities that may hamper his/her ability to study this instrument?
Yes
No
If yes, what?
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Does the student have any physical disabilities that may hamper his/her ability to study this instrument?
Yes
No
If yes, what?
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Do you have any other concerns about the student's ability to study this instrument, or other comments/questions about lessons?
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What day/time would be best for you?
Monday afternoon
Tuesday evening
Wednesday afternoon
Thursday evening
Friday afternoon
Friday evening
Saturday afternoon
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How long would you like the lesson?
30 minutes+
45 minutes
60 minutes
+This is only available for students ages 5 to 7 or those who take theory classes.
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Are you interested in theory classes or computer theory?
No
Yes, computer theory
Yes, classes
Yes, both
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I have filled this form out to the best of my knowledge. I have also read the studio policies, and I understand and agree to everything contained within them.
Yes
No
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Indicates Response Required
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