__

REGISTRATION and PARENT INFORMATION FORM

for 

PRE- COLLEGE PIANO STUDENTS

of

Dr. Nancy Elton

2010-2011

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______________________________________________________

 Both Parents Names__________________________________________________

 Address___________________________________________________________

 _________________________________________________________________

New Students - Referred to Dr. Elton by_____________________________________

Student's Current Age_________Birthday______________________Grade_______

 School____________________________________________________________

 Number of Years of TOTAL Piano Study_____Number of Years with Dr. Elton________

 Other Instruments you Play_____________________________________________

 PHONE NUMBERS:  Home_______________Mom's Work______________________ 

 Mom's Cell_____________________Dad's Work____________________________

 Dad's  Cell_____________________Student's Cell__________________________

 Parent's Email______________________________________________________

 Student's Email_____________________________________________________

 Your SPRING BREAK will be____________________________________________

 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 (or home phone) for the driver or nanny:

________________________________________________________________

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

PARENT SIGNATURE_______________________________________________________

 THANK YOU!

Dr. Nancy Elton