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Student's name *

Birth year *

Student pronouns:

Guardian name (if you are an adult student write "N/A"): *

Adult student or guardian phone number: *

Adult student or guardian email addess: *

Do you consent to receiving phone calls, text messages, emails, and a seasonal email newsletter for the purposes of lesson-related communication? *— Select —YesNo

Does your student have permission to leave on their own after their lesson/class/camp to meet you outside, or will you direct them to wait inside the studio waiting area until you come in to collect them? (If you are an adult student enter "N/A") *

Do you wish to assign a specific pickup persion, or is your student permitted to leave with whoever arrives to pick them up? If yes, provide name of pickup person. If no, enter "no." (If you are an adult student enter "N/A"). *

Does the student have any medical conditions to be aware of in case of emergency (ex: allergies, seizures, diabetes)? If you prefer to discuss this in person rather than include it here, you are welcome to do that.

Would you like to tell me a bit about the student's musical history?

Is there anything else I should know to help me best teach this student (ex: neurodiversity, disability, injury, unpleasant history with music lessons)? If you prefer to discuss this in person rather than include it here, you are welcome to do that.

How did you hear about Kayleigh James Music?