Name *

First Name

Last Name

Phone *

(###)

###

####

Birthday *

MM

DD

YYYY

On practice days, how long will you be at the piano? *

less than 20 minutes

20 minutes

30 min

45 min

60+ min

Do your goals include preparing for RCM examinations?

Yes

No

Maybe

I am interested but need more information

For in-person lessons: are you vaccinated for Covid-19 and able to wear a mask while in the studio? *

Yes, I have received 2 doses of Covid vaccine

Yes, I have received 3 or more doses of Covid vaccine

I have not been vaccinated for Covid-19

Prefer not to answer