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PAULETTE
ALBERTSON, NCTM |
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1. Name
of Student ____________________________________________________________________________ |
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2. Names
of Parents/Guardians__________________________________________________________________ |
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_____________________________________________________________________________________________ |
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3.
Address of Student__________________________________________________________________________ |
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_____________________________________________________________________________________________ |
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4.
Parents'/Guardians' Address (if different) _______________________________________________________ |
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______________________________________________________________________________________________ |
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5. Phone
Numbers (Home and Work)_____________________________________________________________
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_____________________________________________________________________________________________ |
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6. E-Mail
Address______________________________________________________________________________ |
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7.
Student's Birthdate___________________________________________________________________________ |
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8. A.
Homeschooled _____, Grade Level _____ |
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8. B.
Public or |
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9. If
Student has Studied Piano Before I Need to Know His/Her Total Years of Study |
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______________________________________________________________________________________________ |
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10. Other
Activities the Student is Currently Involved in: ____________________________________________ ______________________________________________________________________________________________ 11. Do
you object to the student's picture being on my website? _____________________________________ 12. 12. In
Order To Avoid Assigning A Piece That Might Be Considered By You To Be
Politically Incorrect To Your Child’s Nationality Or Religious Affiliation,
It Would Be Helpful If You Would Supply The Following Information. If You Choose Not To Answer I Will
Understand. Nationality _________________ Religious Affiliation _____________________ |
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