Child’s Name

Address

City, State, Zip

School

Parents’ Names

Occupation(s)

Phone Numbers

Home

Cell

Email Address

School/Grade

Days Available For Lessons:

Previous Years of Piano Study:

Do you currently own an acoustic piano? (Not an electric keyboard)

Insight into Child’s Personality and Extra-Curricular Activities

Please indicate how you plan to help your child develop and follow through

with his/her practice requirements.

How did you find out about Mr. Smith?

Student Application Form

Dr. Ryan F. Smith's Piano Studio

Please provide some basic information about your child's personality and music goals. Also, please indicate extra-curricular involvement.

Monday

Tuesday

Wednesday

Thursday

YesNoWe are in the process of buying one

Church PerformanceConcertStudent ReferralTeacher Referral

Each student must maintain a minimal practice schedule of 5 days per week for the length of his lesson time (e.g., 30-40 minutes each day). Please describe how you will participate in your child's musical training.