Registration Form



Name ______________________________________________

Address_____________________________________________

___________________________________________________

Parent’s Name_______________________________________

Home Phone ________________________________________

Work Phone _________________________________________

Emergency Phone____________________________________

Session Desired_____________________________________

Child’s Age_________________________________________

Birth date___________________________________________

How long has your child played the piano/keyboard?

___________________________________________________

Has your child taken musical instruction other than piano or keyboard?

___________________________________________________

Food Allergies ________________________________________


Print out form, complete, and send to:

Contemporary Keyboard Studios
6051-C Arlington Blvd.
Falls Church, VA 22044