Expertise • Enthusiasm • Excellence

Registration

• New Student Enquiry Form
• Registration Form
• Private Lessons Scheduling
• Chamber Music Scheduling
• Policies

New Student Enquiry Form

Please complete and submit the form below so we can get to know you a little better. Once your form is submitted, call our office at (508) 358-7835, to schedule a free consultation with our Director, Penny Wayne-Shapiro, who will help you choose the best program or instructor to match your needs and reach your goals.

Student's Name:*

First

Last

Month/year of birth (not needed for adult students):

Name of Parent/Guardian (not needed for adult students):

First

Last

E-mail (of Parent/Guardian or Adult Student):*

Preferred Phone:*

Area Code

-

Phone Number

Secondary Phone:

Area Code

-

Phone Number

Address:

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry

Musical Experience:*

No experience

Music Together/Kindermusik

Dalcroze Eurhythmics

Group Piano/Keyboard

Music Theory/History

Private lessons

Orchestra or Ensemble program

Area of Interest:*

Early Childhood (Age 0-5)

Group Class (Ages 5-8)

Private Lessons

Ensembles

Not sure

What are the student's musical goals and ambitions, if applicable?

What are the musical goals and ambitions of the parent/guardian(s) for the student, if applicable?

What kind of teaching style do you think will work best for the student?

Is there anything else you think we should know in order to effectively place the student (e.g. learning style, special needs, gender preference of teacher)?

Please list other interests the student has (e.g. sports, dance):

Please list the days and time ranges the student is available for lessons:

How did you hear about Wayland School of Music?

WSM website / Internet search

Brochure/flyer

Email

Catalog/Calendar in the mail

Newspaper

Heard from a friend

Heard from a music teacher

WSM Facebook page

Other

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