RegistrationAdults

Adult Music Student Registration Form

I. Student Information

Please fill out for 1 or 2 students

* Indicates required field

Student's Last Name(s) *

Student's First Name(s) *

Birthday Month(s) and Day(s) *

Phone Number(s) *

Email(s) *

List any medical conditions, allergies, etc. *

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

Where did you hear from us? *

III. Classes

IV. Method of Payment

Monthly tuition is due or charged by the first class of the new month from the 1st until the 3rd. Example: May tuition is due May 1st-3rd

Monthly Tuition Amount *

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.

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.

Please note that your card will not be charged until we confirm with you the first amount due when starting lessons

Automatic Recurring Billing *

Credit Card/Debit Card

Cardholder's Name *

Type *

Card Number *

Security Code *

Expiration Date *

I authorize Fortepiano Music Studio to charge my account

Electronic Signature of Cardholder *

Date *

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 3 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

Electronic Signature *

Date *

Submit

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Adult Music Student Registration Form