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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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