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Home
About the Studio
About the Teacher
Lessons
Voice
Violin
Piano
Location
Prospective Students
Testimonials
Contact
Prospective Student Information
Tell me a little about yourself!
Student Full Name:
Parent/Guardian Full Name:
(If Student is under 18)
Parent Email/Student Email:
Phone Number:
Street Address:
City/Town:
Student Age:
Student Preferred Pronoun:
Student Occupation/School:
Preferred Lesson Time:
Select One:
Monday & Wednesday evenings (4-8pm)
Sunday afternoons (1pm-5pm)
Lesson Interest:
Select One:
Voice Lessons
Piano Lessons
Violin Lessons
I have taken lessons for:
Select One:
No Prior Lessons
Less than 6 months
More than 6 months
More than 1 year
How did you hear about Roth Music Studio?
Select One:
Recommendation/Word of Mouth
National Association of Teachers of Singing
Boston Singers Resource
Yelp
Google
Other
If Other Referral, Please Specify:
Why are you interested in private lessons?
What are your musical goals?
Attention Voice Students:
Please complete the remaining questions below only if you are a Voice Student. If you are a violin or piano student please skip to the bottom of this form and submit now!
Please rate your note-reading ability:
Select One:
Nonexistent
Beginner
Pretty good
Strong
Above average
Please list any musical instruments played, indicating whether you had private lessons:
List any performance experience; specify role(s) and company/school:
List any choral/chorus experience. Specify voice type.
Additional information about yourself: