Student's Name * First Name Last Name Date of Birth * MM DD YYYY Student's Current Grade Preschool Kindergarden 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Post High school Senior Current City * Child's School Does the student play any other instrument? Yes No How many years has the student studied piano? First timer 1-3 Months 4-6 Months 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years + What was the last CM or (ABRSM or equivalent) level test the student took? Never took the test Prep Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Level 7 Level 8 Level 9 Level 10 Panel / YAG + Please name the current music books the student is currently using, if any. (Title, Publisher Level, etc.) What type of piano do you currently have at home? N/A Upright Grand Hybrid Keyboard (88 keys) Keyboard (non-full size) Please list any competitions the student has done, if any Parent's Name First Name Last Name Parent's Primary Email Address * Parent's Primary Phone Number * (###) ### #### Best time to reach you: * Morning (9am - 12pm) Afternoon (12pm - 4pm) Evening (4pm - 8pm) Anytime works Please select [1] from the following options: * Free trial lesson at Buena Park studio In-home trial lesson -$50 (credited back if you sign up for a monthly plan) Phone consultation If you have a referral, please enter details here. Please use this space to add any additional comments or information you think we should know. Thank you!
