Instructions: Please fill out this form and hit submit when you are finished.
Today’s Date:
Student 1 Last Name:
Student 1 First Name:
Date of Birth:
Age & Grade
Fill out below for any additional family members applying. If only one is applying, skip to "Mailing Address"
Student 2 First Name:
Date of Birth:
Age & Grade:
Student 3 First Name:
Date of Birth:
Age & Grade:
Mother/ Guardian FULL Name:
Father/ Guardian FULL Name:
Mailing Address (Street):
Home Phone:
Mom's Work Phone:
Dad's Work Phone:
Mom's Mobile Phone:
Dad's Mobile Phone:
If student (s) are minors, who will be the primary care provider during the student's lesson time?
I communicate with students and parents primarily through e-mail. List only those e-mails you would like me to send mail to. They should be e-mail addresses that you check the most often.
Mom's E-Mail:
Dad's E-Mail:
Student E-Mail:
Let me get to know you!
Student Interests/ Hobbies:
Describe Music Background of Students (for example, prior music lessons, music classes, singing, other instruments, musical theatre, college coursework, choir, bell choir, Kindermusic,etc.):
Web Photo Permission
Please check one:
For the purpose of educating the public on Keyboard Adventures programs, I give permission for Jennifer Warren Baker, t/a Keyboard Adventures, to publish photographs that include my child participating in Keyboard Adventures events on the studio website, www.keyboardadventures.com.
I would rather not have any photographs that include me/ my child published on the studio website, www. keyboardadventures.com.
Swap List Permission
The swap list is used to swap lesson times with another student when you are unable to make your regular lesson time. Its purpose is to give students a rescheduling option when there are no available makeup times that fit your schedule.
Please check one:
I give permission for my name and contact information (phone & e-mail only) to be published on the swap list.
I do not give permission for my contact information to be published on the swap list.
Required Questionnaire:
The following questionnaire is designed to make sure you are fully equipped to make the most out of your learning experience at Keyboard Adventures. Please consider each question carefully and answer as honestly as you can. Your honest, thoughtful consideration will help prevent any future misunderstandings down the road and ensure the best possible outcome for you and the teacher.
1. Do you understand that good attendance, daily practice,and completion of assignments is required in order to make measurable, observable progress with your piano skills?
2. Do you understand that simply paying tuition and attending lessons will not result in measurable, observable progress?
3. Mrs. Baker is an in-demand teacher and the studio is usually at capacity. Due to the nature of Mrs. Baker's back-to-back lesson schedule, the studio is not able to honor all makeup requests and lesson time changes. Do you fully understand the requirement of keeping the weekly lesson time you are assigned and managing your schedule to keep this time a priority?
4. Although piano lessons only take place once per week, the daily practice requirement means that you can expect to set aside 3 - 4 hours per week for independent practice and instruction. If the student has a great deal of weekly obligations, it would be wise to consider this time requirement carefully. Please list all of the activities the prospective student is involved in outside of school or work, including the number of hours spent each week on each activity (FOR INSTANCE: ballet class 4 hours/ week, show choir 2 hours, council meetings 4 hours, youth group 2 hours, SAT prep class 1 hour):
5. Lessons take place at the Purcellville studio, located in western Loudoun County, Virginia (60 minutes west of Washington, DC, in GOOD TRAFFIC). Since punctuality to lessons is important, students should consider the reliability of their transportation, and the traffic congestion during "after-school" times and rush hour. Describe your transportation situation:
6. Who will be the most likely transportation provider (provided that you get your requested lesson time):
7. Music is a performing art. Do you understand that participation in required recitals is expected (even from the youngest beginners), and students who miss two required recitals may be dismissed from the studio*?
* This requirement may be waived for adult students
8. The studio advocates a traditional curriculum which is supplemented with other genres that the student has an interest in. If there is a specific musical genre you would like [student] to study, please check below (check all that apply):
9. In addition to your private lessons, are you interested in any of the following:
10. Mrs. Baker knows many local school music teachers and is acquainted with their various teaching styles. She is also acquainted with many local church music programs at various churches. By knowing what school and church (if applicable) you attend, Mrs. Baker has a better understanding of your exposure to certain types of music and teaching styles. Which school and/or church do you/ your child attend?
11. When would you like to start lessons?
12. What is the best time for your lesson to take place?
13. Are you willing to go on the wait list if an open time is not available?
14. YOU ARE FINISHED! Hit "submit."
