Student Intake Form Parent / Guardian name * First Name Last Name Student Name * First Name Last Name Does the student have a practice instrument at home? If so, what type? (i.e. keyboard size, pedal, instrument brand, etc.) Why does the student want to take music lessons at GPA? What activities does the student enjoy outside of music? What are the parent/guardian’s expectations for the student’s music lessons? Does the student have any medical diagnoses, learning disabilities or require any special accommodations within a classroom setting? Does the student have any sensitivities to light or sound? Yes No Is there anything else you’d like us to know about the student? Thank you!