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Student Information Form

This document is a student information form for a music studio. It collects general information about the student like name, age, contact details, medical information, and emergency contacts. It asks about the student's musical background, hobbies, extracurriculars, and how they heard about the studio. It requests permission to use photos or videos of the student for promotional materials. The bottom section is for the teacher and collects information about lessons, the student's current skills and materials, goals, and notes.

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NVMonteleone
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44 views

Student Information Form

This document is a student information form for a music studio. It collects general information about the student like name, age, contact details, medical information, and emergency contacts. It asks about the student's musical background, hobbies, extracurriculars, and how they heard about the studio. It requests permission to use photos or videos of the student for promotional materials. The bottom section is for the teacher and collects information about lessons, the student's current skills and materials, goals, and notes.

Uploaded by

NVMonteleone
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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2011-2012

Student Information Form


Please fill out the information below and return to the instructor.
General Information
Student Name _________________________________________ Age _____ DOB __________
School _______________________________________________ Grade ___________________
Parent(s) Name(s) _______________________________________________________________
Address ________________________________________________________________________
Phone Numbers _________________________________________________________________
Emails _________________________________________________________________________
How often is email checked? _______________________________________________________
Preferred method of contact: Home / Cell / Email / Other: _______________________________
Emergency Contact Name/Phone Number (if other than parent) __________________________
_______________________________________________________________________________
Allergy Information ______________________________________________________________
How did you hear about the studio? _________________________________________________

Photo & Video Release
Does the instructor have permission to feature photos and/or videos of this student (never using
full last name) on the studio bulletin board, website, Facebook page, and/or promotional items?
Yes.
Please ask on a case-by-case basis.
No.

Signature ___________________________________________________ Date ______________
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Hobbies or interests ______________________________________________________________
Extra-curricular activities __________________________________________________________
Musical background ______________________________________________________________
Does anyone in the family play the piano, or any other musical instruments? ________________
_______________________________________________________________________________
Please estimate how long the student will be able to practice each day. ____________________
*Is the parent available to help the student with their practice as needed? __________________
*Is the student looking forward to taking piano lessons? ________________________________
*Does the student like school? __________ Favorite subject(s) _________________________
*Describe how your student has exhibited an interest in music and the piano. _______________
_______________________________________________________________________________
Any concerns, or anything else you would like the teacher to know? _______________________
_______________________________________________________________________________
_______________________________________________________________________________
*Not applicable to high school or adult students.

For Teacher Only:
Private Lessons

Other: __________________________

Level __________________________________________________________________________
Current Repertoire/Materials ______________________________________________________
Goals __________________________________________________________________________
_______________________________________________________________________________
Notes _________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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