Private String Instrument Registration Form                Starting Date __/__/__

The purpose of this form is to assist the instructor in teaching your child, assigning a music instruction 
program that best meets his/her needs, and evaluating his progress in the light of his/her motivation, 
natural abilities, and talents.  Please fill out the following information with this in mind.



Child's Name_____________________________________________________________________
Birth date _______________________________  Grade Level ________________    Male     Female
Address _________________________________ City/State/Zip ____________________________
Phone __________________________________ Email ___________________________________
Parent's Names ___________________________________________________________________
Right Handed o        Left Handed o         Birth Order ________        Number of siblings ____________



Has your child ever been tested for musical ability and/or tone deafness? ________________________
Has your child ever had previous music theory instruction? ___________________________________
Has your child taken violin/viola/cello lessons before? _____________ (please indicate which)
If so, how long? ______________  What method/course of instruction? _________________________
Does your child play another instrument? ___________ What? ___________ How long?____________
What is your child's strongest academic ability?  ___________________________________________
________________________________________________________________________________

What is your purpose for having your child develop musical skills on the violin/viola/cello?

o to provide a means for positive socialization
o to encourage natural talent and interest
o for character development and self-discipline
o to increase potential for achievement
o to increase mental and academic capabilities
o to encourage or increase a positive self-image
o for development of skills for the future (professionally oriented)
o other: __________________________________________________


Would your child have a consistent weekly/daily schedule that would encourage 
and assist him/her in setting aside time to practice daily?

           o always                         o most of the time
           o usually consistent         o infrequently
           o seldom                        o developing a schedule (in progress)

Would there be any interferences that would make instruction and regular practice more difficult?  (i.e. health, mental abilities, ADD, ADHD, physical endurance, parent's work schedule, travel)?  Please explain.__________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
What type of schooling is your child involved?  
   o Public       o Private      o Home Education         o Montessori       o Other: ____________
What school does your child attend? ____________________________________________________
What curriculum does your child use if he/she is home educated?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

List extra-curricular activities/socialization that your child is actively participating in this year.  (i.e. hobbies, 
interests, arts, theatre, dance, community service, physical education, sports, and church functions, etc.)
________________________________________  _______________________________________
________________________________________  _______________________________________
________________________________________  _______________________________________
________________________________________  _______________________________________

List any possible special events, outings, or activities that your child plans on participating in this year.  (i.e. 
vacation Bible school, revival meetings, field trips, Christmas programs, camping trips, extended travel, etc.)
________________________________________  _______________________________________
________________________________________  _______________________________________
________________________________________  _______________________________________
________________________________________  _______________________________________

List extra-curricular activities/socialization that your child is actively participating in this year.  (i.e. hobbies, 
interests, arts, theatre, dance, community service, physical education, sports, and church functions, etc.)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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Thank you for your cooperation in providing this information!  This data will aid me as I teach your child the fundamentals of music on the most beautiful and versatile of musical instruments (in my opinion!).  I look forward to working with your child and assisting you in this area of his/her training. Praising Him with the Strings (Psalm 33:3).  
Cori Jones