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Teri Slade
Student Information Sheet
This form should be completed
after
you have confirmed a lesson time with Teri. If you wish to submit this information in hard copy, you may print the form
here
, and bring the completed form to your first lesson.
Student
*
Indicates required field
Name
*
First
Last
Date of Birth
*
Mailing Address
*
Alternate Mailing Address (if guardians do not share an address)
*
Preferred Payment Method
*
Option 1 - pay by semester
Option 2 - pay by month
Option 3 - post-dated cheques
Pay by lesson (available for adult and Body Mapping students only)
Instrument (piano and/or voice)
*
Year the student began/will begin lessons on their chosen instrument(s)
*
Allergies
*
Any medical conditions of which the teacher should be aware
*
Any additional information of which the teacher should be aware
*
Guardian 1 (if applicable)
Name
*
First
Last
Relationship to student
*
Home phone
*
Cell phone
*
Work phone
*
Email address
*
Best method of contact
*
Home phone
Work phone
Cell phone (calling)
Cell phone (text message)
Email
Guardian 2 (if applicable)
Name
*
First
Last
Relation to student
*
Home phone
*
Cell phone
*
Work phone
*
Email
*
Best method of contact
*
Home phone
Work phone
Cell phone (calling)
Cell phone (text message)
Email
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