Registration

Student's Name *

First

Last

Student's Age (d.o.b.) *

Student's Grade in School *

Amount of prior piano study (if any). *

Play (or played) other instruments? *

Parent's Name (1) *

First

Last

Address (if different) *

Line 1

Line 2

City

State

Zip Code

Country

Parent's Name (2 - if applicable) *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

What are your goals for your child's piano study? *

What are your child's goals with piano study? *

What are your child's extra-curricular activities? *

What are your favorite music styles? Favorite XM radio channels etc? *

What are some of your child's favorite artists, music styles, songs etc.? *

What are your child's favorite books? *

Which of the following programs are you interested in for your child? *

Private Piano Instruction (in person) Preschool Piano Classes Advanced study in Taubman Approach

Which of the following programs are you interested in for your child? (Check as many as you prefer) *

Are you familiar with Dorothy Taubman, The Golandsky Piano Institute, The Taubman Approach? *

Yes No

Any previous music training (parent/s)? This can include choir, band, any age. *

How did you hear about Birmingham Piano? *

Registration - Pre-College Student