The Right Chord Piano Studio

On-Line Application
Home
Welcome Letter
A Brief Biography of Mr. Miller
Finding the Right Teacher
When and Why Should Children Study Piano?
Music for Little Mozarts
Piano -- The Therapeutic Miracle for Adults
Our philosophy and methodology
Computer Lab
Testimonials from Students
Studio Policies and Fees
On-Line Application
On-Line Fee Payment

Registration Form
(Please print, complete, and fax to 877-229-6360.  To reserve a space, registration fee should be submitted on line by clicking on the "On-Line Fee Payment" option on the menu bar and following instructions.)

Student first name_______________ Student last name____________

Student Birthdate____________Parent title (Dr., Mrs, Mr., Ms.) _____

Parent’s first name___________Parent’s last name ________________

Address_1 _________________________________________________

Address_2 _________________________________________________

City ___________________State______________ Zip _____________

Cell phone ____________________Home phone __________________

Email address ______________________________________________

Has the student studied previously? ______________ For how long?

_____________ With whom? __________________________________

If the student has studied piano previously, at what level is he or she

currently? _________________________________________________

Has the student previously studied music other than piano? ________

If so, please elaborate _______________________________________

__________________________________________________________

Are the parents musicians? ___________________________________

Is there a piano in the home? __________________________________

If so, what kind? _____________________________________________

Are there any special needs?__________________________________

What are the goals that you wish to achieve?

__________________________________________________________

__________________________________________________________

Are you willing to see that the student practices 20-30 minutes each day?

__________________________________________________________

Please indicate a first, second, and third choice for your preferred day of

the week and time of day for your lessons.

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

How did you learn about The RIght Chord Piano Studio? ______________

____________________________________________________________

____________________________________________________________ 

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