Student/Parent and/or Guardian Information
(just answer the questions you feel comfortable with)
 
Student Name:  
Guardian Name:  
Home Phone #:  
Cell Phone #:  
Work Phone #:  
Partner's Phone #:  
Any other emergency phone #'s:  
Address/City/State/Zip:  
Alternative Address/City/State/Zip:  
Email:  
Student Expectations:
What do you expect from these lessons?
(please check one that most fits)		  
personal growth
enjoyment and enrichment
professional pianist
performer
compose your own music
Make a list of your favorite songs and musicians:
(for the student)		  
Music you are most interested in learning:
(please check appropriate styles) 		 
classical
rock
improvisation
experimental
jazz
standard Broadway hits
traditional standards
folk
religious
compose your own music
List some songs that you want to learn
how to play on the piano.
 
!!Food is Fuel....
Please make sure student has eaten prior to lesson. As we all know... we as humans focus and learn better when we feed our bodies to feed our mind. (Please NO HIGH FRUTOSE SNACKS or soda's before a session.) If student is hungry and not paying attention, I may give them a quick snack.
 
*** Please list here any special food requirements and or known food allergies.  
     
Would it be OK for other perspective students to contact you for recommendations?  
yes   no
 
Comments and/or Missalaneous Concerns
 
Please sign here with your initials:

If you would rather send this through snail mail please print, fill out all the appropriate questions, date, sign and send to:

88 Keys School of Piano
c/o Salane Schultz
48-5th Avenue
Oakland, CA 94606

Thank you. I will contact you shortly.

Respectfully,
Salane C. Schultz