ENROLLMENT FORM

Name of Student: _________________________________ Age: ___ Sex: ___ Date of Birth (M/D/Y): __________
Residential Address: ___________________________________________________________________________
Telephone Number: _______________ Mobile Number: ________________ E-mail: _______________________
Name of Parent or Guardian: __________________________________
Type of Enrollment (Check one): Basic ( ) Adult ( ) Integrative School of Pianoforte ( )
Does the student have previous piano/music schooling before? YES ( ) NO ( )
Name of previous teacher and institution: _____________________________________________
If student is non-beginner, please state reason for stopping or change of teacher/school:
___________________________________________________________________________________________
____________________________________________________________________________________

I hereby certify that the above information is true and correct.

______________________________________
SIGNATURE OVER PRINTED NAME

*Parents or guardian must sign the form if the student is below 18 years old.