Sign-up Survey Student Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Student Date of Birth * MM DD YYYY Parent/Guardian Name Fill in if Student is under 18 First Name Last Name Parent/Guardian Address Fill in if different than the above address. Address 1 Address 2 City State/Province Zip/Postal Code Country Primary Phone * (###) ### #### Secondary Phone (###) ### #### Email * Preferred Method of Communication * Select all that apply. Phone Text Email How would you best describe the student's current music education: * New: Limited to no training Beginner: Basic music reading skills. Has 0-1 years of formal training Intermediate: Reads music with some degree of proficiency. Has 1-5 years of formal training Advanced: Reads music with proficiency. Has 5+ years of formal training Other: Please Explain Other Which style(s) or categories interest you the most * (select all that apply) I just want to learn to play music! Classical Jazz Musical Theatre Pop Competitions & Festivals Examinations Gig Preparation Mature Student/Continuing Education Music Theory/Harmony/History Learn how to read music Other: please explain Other If applicable, describe the piano or keyboard that you will be using to learn: Please use this area to add any more information that may be relevant to the student’s music education: (Other instruments, choir experience, special needs, parents who want to help their children etc.) Thank you!