Student Name *

First Name

Last Name

Parent Name (students under 18)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Instrument and/or Subject *

Check all that apply.

Piano

Vocals

Production

Songwriting

Date you would like to begin *

MM

DD

YYYY

Availability *

Please select all days that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

What aspects of music education interest you the most? Check all that apply. *

Playing my favorite songs by ear by understanding music theory

Playing the greatest classical composers of all time

Learning great technique, reading and doing things traditionally

Becoming free and fluent enough to express myself without boundaries

Client Agreement *

Please check the boxes below indicating you've read our guidelines and requirements.

I understand that without consistent practice, results are NOT guaranteed.

I am able to commit to a practice schedule of at least 3 days a week for 15-20 minutes.

I understand that students who are minors MUST have a parent involved in their learning process to obtain the best results.

I understand that Modern Pianista curriculum focuses on ear training and music theory and if I'd like to learn more than the basics of reading, an additional lesson day is required.