This application is for those who are interested in becoming students at Kato
Music Studio. In order for an appropriate lesson plan to be ready to start from the very first lesson,
you must e-mail the answers at least seven days in advance of
the first lesson
to: MsKato@KatoMusicStudio.com
New Student Application and Agreement Form
Student Information
Student Name:
_______________________________________________________
Date of Birth:
_______________________________________________________
Home Phone:
_______________________________________________________
Work Phone:
_______________________________________________________
E-mail:
_______________________________________________________
Mailing Address:
_______________________________________________________
City, State, Zip:
_______________________________________________________
Parent/Guardian (in case of emergency contact):
_______________________________________________________
Previous Music Experience? ( Y / N )
Instrument/# of Years Studied:
_______________________________________________________
Previous method books, technique books used:
_______________________________________________________
Participated in Certificate of Merit? ( Y / N )
If yes, specify last grade level passed:
_______________________________________________________
Path A, Path A Alternative, or Path B? (circle one)
Please list any participation in workshops, recitals, festivals, competitions or other musical activities:
_______________________________________________________
Musical Interests
The following is just a small list of reasons why people come to Kato Music
Studio for lessons. Please indicate any which apply to you
and please feel free to clarify or add to the list. This information helps in
determining appropriate methods and musical literature for the individual student.
Experienced - Want to work on advanced musicianship
Experienced with gaps in knowledge - remedial technique, music theory, musicianship, etc.
Interested in composition
Interested in standard classical repertoire
Interested in jazz
Interested in popular styles
Interested in Certificate of Merit
Interested in competitions
Adult student - studying for fun or personal growth
DON'T KNOW - open for anything!
OTHER:
For Primary through High School Students
Grade Level:
_______________________________________________________
Enrolled in Special Academic Programs
("Magnet", G.A.T.E, M.G.M., etc.)? ( Y / N )
Which Program?:
_______________________________________________________
Who referred you to Kato Music Studio?
Current Student / Parent of Student:
__________________________________________
Music Teachers Association Referral:
__________________________________________
Other Referral:
__________________________________________
PARENT or GUARDIAN (if applicable):
_______________________________________________________
SIGNATURE:
________________________________________DATE:__________
STUDENT:
_______________________________________________________
SIGNATURE:
________________________________________DATE:__________
|
