Home
About
Body Mapping
Course
Lessons and Workshops
Research
Private Music Lessons
Registration
Resources
Contact
Contact form
Email notifications
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
Submit