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David Husser Music

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David Husser Music

About
Piano Studio
Theory
- About Worksheets
- Store

Registration 2021

Contact Information

Please complete all fields

Last (Family) Name *

Primary Email Address *

Primary Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Information

Please complete applicable fields

Mother's Name

First Name

Last Name

Mother's Email

Mother's Phone

(###)

###

####

Father's Name

First Name

Last Name

Father's Email

Father's Phone

(###)

###

####

Student Information

Student #1

Student #1 Name *

First Name

Last Name

Student #1 Grade *

Student #1 School *

Student #1 Birthdate *

MM

DD

YYYY

Student #1 Lesson Length *

Is student #1 interested in participating in Student Achievement Testing (March 2022)? *

Yes

Maybe

No

Student #2

Student #2 Name

First Name

Last Name

Student #2 Grade

Student #2 School

Student #2 Birthdate

MM

DD

YYYY

Student #2 Lesson Length

Is student #2 interested in participating in Student Achievement Testing (March 2022)?

Yes

Maybe

No

Home Instrument

What type(s) of instrument(s) do you have at home? *

Check all that apply.

Grand piano

Upright piano

Electronic keyboard/Digital piano

None

Preferred lesson times

First day preference *

First day preferred time range *

Second day preference *

Second day preferred time range *

Third day preference *

Third day preferred time range *

Final Section

*

Please read the 2021 studio policies (available under Piano Studio > Resources) and review the potential Covid-related lesson procedures referenced in the registration email and survey.

I have read the 2021 studio policies and am aware of the lesson procedures for this year.

Comments

Thank you!