Student Name
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First Name
Last Name
Student Email
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Student Phone Number
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(###)
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Student Age
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Student Grade
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Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
High School - Freshman
High School - Sophomore
High School - Junior
High School - Senior
College - Freshman
College - Sophomore
College - Junior
College - Senior
Other
Student School
Parent/Guardian Name
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First Name
Last Name
Parent/Guardian Email
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Parent/Guardian Phone Number
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(###)
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Parent/Guardian Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Is this address different from the student's address?
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Did anyone refer you to Keen Voice Studio? If so, who?
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Emergency Contact Name
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First Name
Last Name
Emergency Contact Phone Number
*
(###)
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Emergency Contact's Relation to Student
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Has the student had any previous vocal training? If so, with whom and for how long?
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Does the student have any previous experience in choir, musicals, plays, etc.? Please describe.
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Does the student play any instruments? If so, what instruments and what is their proficiency level?
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Is the student able to read music? If so, what is their proficiency level?
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No Knowledge
Basic Knowledge
Intermediate Knowledge
Advanced Knowledge
Expert Knowledge
Has the student had previous vocal injuries, nodules, polyps, surgeries, therapy, allergies, TMJD, asthma, chronic hoarseness, dental issues, acid reflux, etc. If so, please explain.
What are some short term goals the student wishes to achieve with singing lessons?
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What are some long term goals the student wishes to achieve with singing lessons?
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Please give us days/times (weekdays only) you are available if we decide to move forward with lessons. The studio has a waiting list (slots open up from time to time) and those who are the most flexible are more likely to secure a lesson slot.
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