Sign up for Private Piano Group Piano Private Vocal Group Vocal Keys and Me MusicWorks MusicTime Child's Name First Name Last Name Child's Date of Birth MM DD YYYY School Grade Pre-K Kindergarten 1 2 3 4 5 6 7 8 9 10 11 12 Other Mother's Name First Name Last Name Mothers's Cell (###) ### #### Mother's Email Father's Name First Name Last Name Father's Cell (###) ### #### Father's Email Other Caregiver (that may be providing transportation to the lesson) First Name Last Name Other Caregiver's phone number. (###) ### #### Student's Address Address 1 Address 2 City State/Province Zip/Postal Code Country Allergies/Special Needs Musical Experience if Any Does your Child Like to Read? Yes No If So, what types of books (specific series, titles)? Does your child like to listen to music? Yes No If so, what styles of music (specific types, names of songs)? Describe your child's personality. Describe your child's learning style. Any other Comments that would be helpful to know about your child I have read the studio policies and agree to adhere by them (electronic signature and date) * Date * MM DD YYYY Thank you!