Please mail this form along with the registration fee to Angela at her address to sign up for lessons.
New Student Registration Form
Student Name_____________________________________ Birthday ___________________________
Grade ___________ School________________________________________ Years of Study _______
Parent’s Name ________________________________ Cell Phone number________________________
Mailing Address ________________________________________________________________________
Preferred means of contact: (please circle) Email / Phone Call / Texting
Home Phone _____________________Emergency Contact (other than parent) ___________________
Allergy /Special Needs __________________________________________________________________
___ 30 minute traditional piano ____30 minute vocal ___ 60 minute vocal/piano combo
___ 45 minute traditional piano ____ 45 minute vocal ____45 minute piano/chordal combo
____ other (add to piano or voice combo of drumming/theory/worship team/improve/)
Fall Studio Hours
Monday Tuesday Wednesday Thursday
2:00-5:00 3:00-5:00 2:00-2:45 4:00-5:00
6:30-8:30 6:30-8:30 6:30-8:30
Please share your top three lesson slots including day and time based on my hours.
Please circle all group lesson time slots that work with your schedule to help me determine group lessons. (Group Lessons/parties will happen 1-2 times a semester and will replace normal lessons that week. I hope to divide up age groups for smaller groups at times if schedules allow.)
*Mondays 4:00-5:30 * Friday 4:00-5:30 * Fridays 6:00-7:30 * Thursdays 6:00-7:30
Yes/No I give permission for my child to pick from the prize box that may include food items.
Yes/ No I give permission for my child’s picture and first name or initial to be used in publications for A. G. Studios.?
I’d love to add congratulations when finishing a level, acknowledging accomplishments, or showing games/activities we do.
Yes/No I give permission for my child to be in video’s promoting A.G. Studios or showing cup percussion/recital/ or other activities.
A picture or video is a great way to truly show what is happening in studio.
For piano students, does your child have a piano or keyboard at home to practice on? If so, what kind?____________________
For vocal students, does your student have a good speaker to use when practicing and a device to play digital files from? _________________________________
Student’s background in music/goals______________________________________________________
Any special needs that a teacher needs to be aware of? Any learning struggles, anxiety, diagnosis? These truly are helpful to know when teaching students and help me add in my special training when needed and will be kept confidential. _________________________________________________
Is there a parent willing to help with practice when needed? ___________________________________
Does anyone else in the family play an instrument, sing, or read music?__________________________
Has the student taken lessons before? If so what was your favorite part? _________________________
What was your least favorite part of those lessons? ______________________________________
Payment info: ______ I will make my tuition payment in two monthly installments
______ I will make my tuition payment up front for the semester
I understand that I am committing to an entire Semester of music lessons that can be paid in monthly payments at the first lesson of each month or one payment at the beginning of the semester.
I understand that Fall & Spring semesters do not allow for makeup lessons due to a full schedule.
I have read and understand the above information and have read the policies at http://www.freewebs.com/agstudios/studiopolicies.htm .
Date ________________________ Name _______________________________________________