Student Intake Form

Clare Bresnahan, Violin

Student Basic Info

Student Name

First Name

Last Name

Current Age/Grade

Student Email

Student Phone

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Parent/Guardian Basic Info

First Parent/Guardian Name

First Name

Last Name

First Parent/Guardian Email

First Parent Guardian Phone

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Second Parent/Guardian Name

First Name

Last Name

Second Parent/Guardian Email

Second Parent/Guardian Phone

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History, Goals, and Additional Info

Past Musical Experience

Are you experienced or just starting? Have you played other instruments or sung in the past? Have you participated in school orchestra, community orchestra, private lessons?

Lesson Goals

Why are you taking lessons (e.g. for fun, to prepare for an audition, etc.)? Do you have any particular goals in mind?

Learning Style/Needs

How do you feel you learn best? Do you have any learning challenges I should be aware of?

Relevant Allergies/Health Concerns

Comments

Is there anything else you would like to share with me?