CSA Private Lesson, Suzuki Little Stars and Beethoven's Buddies Registration Form

Student Name - Proper name, no nickname*

First NameLast Name

Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

Date

Gender*

FemaleMale

Current Grade*

Adult Student*

YesNo

Adult Student Phone

Area CodePhone Number

Adult Student e-mail*

Primary Phone Number*

Area CodePhone Number

Secondary Phone Number

Area CodePhone Number

Mother's Name (enter N/A if not applicable) - Proper name, no nickname*

First NameLast Name

Mother's Email*

example@example.com

Mother's Cell Phone *

Area CodePhone Number

Father's Name (enter N/A if not applicable) - Proper name, no nickname*

First NameLast Name

Father's Email*

example@example.com

Father's Cell Phone*

Area CodePhone Number

Primary Contact Person*

MotherFatherOther

Primary Contact Person (other than Mother or Father)

First NameLast Name

Primary Contact Cell Phone (other than Mother or Father)

Area CodePhone Number

Primary Contact Email (other than Mother or Father)*

example@example.com

Use Student Address for Billing

YesNo

Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

In an emergency, CSA should call:*

MotherFatherOther

Medical Treatment Agreement*

I authorize CSA to seek emergency medical treatment for this student, if necessary.

How did you hear about CSA?*

Program of Interest*

Private LessonsSuzuki Little StarsBeethoven's Buddies Clementi's Colorful Chimes ClassBeethoven's Buddies Private Lessons

Private Lessons

SuzukiPreparatory

Beginning Student

YesNo

Transfer Student

List previous years of study/School/Teacher/Group

Instrument

Lesson Length

Availability

	Rank your preference for lesson days #1-3	Earliest Start Time	Latest End Time	Comments
MON
TUE
WED
THU
FRI
SAT

Teacher preference

Beethoven's Buddies Chimes Class*

Suzuki Little Stars Class Selection *

Select drop down arrow to see days/times for Piano or Strings Suzuki Little Stars classes

I would like to begin instruction

Fall semesterSpring semesterSummer semesterAs soon as possible

Suzuki Only*

Suzuki registrants only: I have completed the required online observation videos.

Piano Private Lessons or Little Stars Piano Class Only

I currently own an acoustic pianoI currently own an 88-key, weighted keyboardI currently do not own a piano or electric keyboard

CSA Policies

Registration
Admission to private and class instruction begins with completion of a new student registration form and submission of the non-refundable registration fee. Students registered for fall lessons/classes are automatically renewed for second semester. Any changes (including withdrawal) must be communicated in writing prior to the start of second semester (csa@wheaton.edu). Once second semester begins, all regular attendance/withdrawal policies are in effect. The annual non-refundable re-registration fee of $20 for continuing students will be applied to each student’s account.

Changes in enrollment
Withdrawal
Notification of any student withdrawal must be submitted to the office in writing (csa@wheaton.edu). A $35 cancellation fee will be assessed for students who enroll and subsequently withdraw prior to the first class. A student who withdraws during the first four weeks of the semester will be charged for the weeks prior to withdrawal, plus 50% of the semester’s remaining tuition. For a withdrawal after week four of the semester there is no tuition refund except in the case of serious illness or relocation, the final determination of which shall be made by CSA.

Change in Lesson Length
Any change in the duration of lessons are at the discretion of the teacher.

Suzuki/Prep Groups
Group classes are assigned according to the student's level and experience. Once a group assignment is made, it is not our policy to accommodate changes. If a family chooses not to participate in group class, there will be no tuition adjustment.

Tuition and payments
Tuition for private and group instruction is billed by semester and payable in full by 12/10 (Fall semester), 4/10 (Spring semester), and 8/10 (Summer semester). Statements are sent monthly to the email on file. Monthly payments are acceptable. A $50 fee will be assessed for any returned checks.

Past Due Accounts
Delinquent accounts will be charged a 7% fee following each semester/summer. CSA reserves the right to suspend or discontinue instruction of any student with a past due account.

Attendance/make-up
Students are expected to be present for all lessons and classes.

Private Instruction
If a student cancels a lesson, the teacher is not obligated to make up the lesson, nor will tuition be adjusted. If the teacher cancels the lesson, it will be made up. Parents are encouraged to trade lessons when conflicts arise. It is the student’s responsibility to verify time/location of a traded lesson. Please notify the teacher of a cancellation or trade prior to the lesson.

Group Instruction
Class absences may not be made up. When a teacher is absent the class will be made up if a substitute is not available.

Tuition assistance
Thanks to the generous support of our Annual Campaign contributors, limited tuition assistance is available for students with demonstrated need. Aid is awarded based on documented tax returns, family size, and is subject to availability of funds as well as facility and program capacity.

Applications are reviewed twice a year and strict deadlines are as follows:

July 1—Fall semester
November 1—Spring Semester

Health policy
Providing a healthy environment for all participants in CSA is a priority to the organization. Therefore, CSA and Wheaton College reserve the right to limit attendance at lessons/classes to teachers and students, determined at our discretion, not to be a health risk to others. Participants suffering from infectious diseases, open wounds, persistent coughs or colds or other potentially transmissible health conditions are to cancel lessons. The effect on tuition of such changes will be in accordance with the Attendance/Make-up Policy.

Teacher conferences
Parent/teacher conferences are held in January for all private lesson students. A specific lesson will be designated as a conference time.

Student photographs
Photographs and video footage of students engaged in class, lessons, or performance activities may be used for publicity purposes.

Weather cancellations
CSA does not necessarily follow public school cancellations. When weather conditions are questionable, cancellation notification will be as follows: Classes—check CSA website at csa.wheaton.edu. Private Lessons—teachers will notify students.

Equal opportunity
CSA does not discriminate on the basis of race, color, age, nationality, sex, ethnic origin, or religious belief in its admission, financial aid or other educational policies.

E-mail
We communicate many important details via e-mail. Please add csa@wheaton.edu to your contacts.

Questions about Registration?

If you have any questions, please enter them here and the office will contact you.

Withdrawal Policy*

I acknowledge and agree to the following Withdrawal Policy: Notification of any student withdrawal must be submitted to the office in writing (csa@wheaton.edu). A $35 cancellation fee will be assessed for students who enroll and subsequently withdraw prior to the first class. A student who withdraws during the first four weeks of the semester will be charged for the weeks prior to withdrawal, plus 50% of the semester’s remaining tuition. For a withdrawal after week four of the semester there is no tuition refund except in the case of serious illness or relocation, the final determination of which shall be made by CSA.

Policies*

I have read and agree to all the CSA policies and procedures found at csa.wheaton.edu. Subject to these conditions, I agree to pay for all charges and services rendered.

Required $35 New Student Registration Fee*

I agree to submit the required $35 non-refundable registration fee to the CSA office within one week. Class or lesson placement will not begin until this fee has been received. Credit cards are not accepted at CSA, please mail check payment to Wheaton College CSA, 501 College Avenue, Wheaton, IL 60187.

Discounts (check all that apply)

Wheaton College EmployeeSibling DiscountOther

If you selected Wheaton College Employee above , please fill in the employee name Employee Name , Wheaton College department College Department , employee title Employee Title and relationship to student Relationship. This information will be verified by the Human Resources department. Thank you.

Promotional Code

Signature*

Print Signature name*

Date*

Date

CSA Student Registration & Contract Private Lessons Suzuki Little Stars and Beethoven's Buddies