RegistrationAdults

Student's Last Name *

Student's First Name *

Birthday *

Phone Number *

Email *

List any medical conditions, allergies, etc. *

Student's Last Name *

Student's First Name *

Birthday *

What are the best ways to contact you? *

Phone Call Text Email

What are the best times to contact you by phone call? *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Person *

First

Last

Emergency Contact Phone *

Where did you hear from us? *

IV. Method of Payment

Monthly tuition is due or charged by the first class of the new month from the 1st until the 7th. Example: May tuition is due May 1st-7th

Tuition each month remains the same regardless of the number of lessons and/or weeks in a month, regardless of holidays and the student’s attendance, and regardless of extended travel by the student and the instructor. Most months have 4 classes. Months that have 5 classes are balanced with months that have 3 classes.

Please select one of the following payment options below:

First Option: Best
Automatic Recurring Billing

To help save you time and energy, we encourage you to set up automatic credit card/debit card recurring billing for music lessons. This will save you considerable time because the same amount will be charged to your credit/debit card and never have to think of it again! Plus your payment will always be on time.

I authorize Fortepiano Music Studio to charge my account

Electronic Signature of Cardholder *

Date *

Second Option: Good
Paypal Invoice

This is a good option if you prefer to make payments manually between the 1st and 7th of every month. A monthly invoice will be sent to your email. You can pay tuition Online using the PayPal Invoice. Other accepted forms of payment in person or by mail include check, cash, or credit/debit card. You can also enroll in PayPal Subscriptions and Recurring Payments or set up Online Bill Pay set up through your bank

I elect to make monthly payments by paying online, by check, cash, credit card, enrolling in PayPal Subscriptions and Recurring Payments, or set up Online Bill pay through my bank.

V. Studio Adherence Statement

Your electronic signature indicates your understanding of the guidelines of the Fortepiano Music Studio Guidelines pertaining to Fortepiano Music Studio and agree to abide by their stipulations. Please read the 11 Helpful Things about Tuition, Cancellations, and Make-up Lessons at the bottom of the page

Please Select *

I have read the 11 Helpful Things about Tuition, Cancellations, and Make-up Lessons

Electronic Signature *

Date *

VI. Media Release Consent

Occasionally, photos or video of students are taken during lessons and performances for use in studio newsletters, studio social media, advertising materials, lessons demonstrations, and studio owned websites. The Media Release is found at the end of the Studio Guidelines

Please Check One *

YES, the Studio may use recordings & images of me in the manner described abov NO, the Studio may not use any recordings or images of me in the manner described above

Adult Music Student Registration Form