Southern California Suzuki Institute

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Student Registration Form – Submit a separate application for each student
 PRINT FORMS HERE:    Application & Payment     Do not print this webpage.
                            
          Application only             Payment only          Enrichment only

STUDENT INFORMATION (pianists please indicate if right-hand only)
First Name_____________________________ Last Name ______________________________________
Sex: M F Date of Birth___________________ Age (on 7/19/10)________
Parent ______________________________________ Phone______________________

Email_________________@__________________

Address_____________________________ City____________________ State_______ Zip_____________

INSTRUMENT T-Shirt size (circle only one) Child S M L OR Adult S M L XL

LEVEL: (Select one) Twinkler_____ Books 1 – 3_____ Books 4 – 6_____ Books 7 – up_____

Current Piece: Book #___________ (the piece being studied at the time of enrollment)
Piece Title (including movement)___________________________________
Composer_____________________________

Polished Piece: Book #___________
Piece Title (including movement) ___________________________
Composer_____________________
READING ABILITY: (This is used to determine orchestra scheduling. ) Music seen at first sight:  circle one letter
and include the book number if ‘D’.

A. None
B. Recognizes notes, symbols, rhythms
C. Sight-reads simple melodies
D. Sight reads at Suzuki Book # _____
E. Orchestra experience (None, 1 yr, 2yrs, etc.)______

ENRICHMENT CLASS ($30) - Choose first & second choice:  ___ None  ___ Intro to Chamber Music  ___ Dalcroze Eurthythmics ___ Music Theory Games (orchestra students only)     ___ Intro to Jazz    ___  Vibrato (need your teacher’s permission) __ Suzuki Music & Movement Ages 0 - 3 _____Viola for Violinists
                                                 Enrichment classes must have a minimum enrollment of 6.

___________________________________ ____________________________________
Teacher’s Name (please print) Teacher’s Signature (verify that Book & Piece # are correct)

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