Kato Music Studio Grand Piano
Student Application and Agreement Form
<- BACK | HOME | NEXT ->
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


Please review the Studio Policy before signing at the bottom!


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:

    __________________________________________

I understand the Studio Policy and I accept its terms.

PARENT or GUARDIAN (if applicable):

_______________________________________________________

SIGNATURE:

________________________________________DATE:__________

STUDENT:

_______________________________________________________

SIGNATURE:

________________________________________DATE:__________

© 2002, Kato Music Studio