__

REGISTRATION and PARENT INFORMATION FORM

for 

PRE- COLLEGE PIANO STUDENTS

of

Dr. Nancy Elton

2018/19

Parents:  Please print out this form and complete with your signature, indicating that you understand the Teaching Policies, and return to me by first lesson.  Thanks so much. PLEASE PRINT LEGIBLY!

 Today's Date____________________

 Student Name______________________________________________________

 Parent's Names  Mom_____________________Dad_________________________

 Address__________________________________________________________

 ________________________________________________________________

New Students - Referred to Dr. Elton by_____________________________________

Student's Current Age_________Birthday and Year_______________Grade________

 School___________________________________________________________

 Number of Years of TOTAL Piano Study____Number os Years with Dr. Elton__________

 Piano Competitions you have previously entered ______________________________

 _______________________________________________________________

Other Instruments you Play_____________________________________________

 PHONE NUMBERS:  Home_______________Mom's Work_____________________ 

 Mom's Cell_____________________Dad's Work___________________________

 Dad's  Cell_____________________Student's Cell__________________________

 Parent Email-mom__________________________________________________

Parent Email -dad___________________________________________________

Student's Email_____________________________________________________

 If your child is being driven to the lesson on a regular basis by someone other than the parent, please provide the name and cell number for the driver:

 _______________________________________________________________

 Your signature indicates that you have read and understand the teaching policies of my studio. 

PARENT SIGNATURE_______________________________________________________

 THANK YOU!

Dr. Nancy Elton