This form is to register for lessons under the studio policies for the 2018 school year in my home studio. If you have not yet read these policies, take the time to do so now. Completion of this form indicates you thoroughly understand and agree to these policies. Any questions, please let me know.

Student's name

First Name

Last Name

Student's date of birth

(if under age 18)

MM

DD

YYYY

Parent's name

(if student is under age 18)

First Name

Last Name

Student's address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's phone number

(###)

###

####

Email address

Instrument

Lesson length

Unless arranged otherwise, lessons are assumed to be weekly and offered in 15-minute increments.

Scheduled lesson day

Select the day of the week agreed-to for your regular lesson time.

Scheduled lesson time

Enter the time of your regularly scheduled lesson.

Hour

Minute

Second

Do you consent to allow photos of the registering student to be published on this website?

Refusal does not preclude the student from taking lessons.

Yes

No

Additional comments/questions:

Electronic Signature

Your typed name in this field indicate that you have thoroughly read, understood, and agreed to follow the current policies established by this studio, including the new payment schedule.