| Student's Full Name: |
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| Nickname: |
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| Date of Birth: (month, date, year) |
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| Grade in Fall: |
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| Parents' Names: |
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| Home Address: |
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| Primary Phone No.: |
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| Secondary Phone No.: |
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| E-Mail Address: |
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| Please describe any previous piano experience your child has had (teacher(s), books used, years of study, etc.): |
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Please describe the practice environment your child will have access to on a daily basis (type of piano/keyboard, location of piano/keyboard, number of keys if using a keyboard):
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| Please list your top three choices for lesson days/times: |
1st:
2nd:
3rd:
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Note:
Lessons are -
- 30 minute lessons - $15
- 45 minute lessons - $22.50
- 60 minute lessons - $30
Monthly payment is due in advance, at the first lesson of each month.
Please make your checks payable to "WIU Community Music School" and give payment
directly
to the teacher at the first lesson of each month.
Please carefully review the Piano Program Handbook, available online, for
additional information, policies and important dates:
Community Music School.
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