Lesson Request Form
Student Information
Student Name
First Name
Last Name
Parent/Guardian Name (if applicable)
First Name
Last Name
Student Birthdate
Please select a month
January
February
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December
Month
Please select a day
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Day
Please select a year
2024
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Year
Student Email
example@example.com
Parent/Guardian Email
example@example.com
Student Phone Number
-
Area Code
Phone Number
Parent/Guardian Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Name
Student Grade
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
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Lesson Information
What type of lessons are you interested in?
Voice Lessons with Zach
Voice Lessons with Ginny
Acting Lessons with Ginny
How often would you like to have lessons?
One-Time Trial Lesson
Project Specific Lessons (Audition Coaching, Show Performance Coaching, etc.)
Weekly Lessons
Other
If you are requesting Project Specific Lessons, please describe the project, timeline, and amount of lessons you are requesting.
Are you interested in a 30-minute lesson or an hour lesson?
30-Minute
Hour
Other
What day of the week would you prefer for your lesson(s)? Select all that apply.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What date would you like to start your lessons?
-
Month
-
Day
Year
Date
Please note that all lessons are virtual at this time. Please select your preferred video call service.
Zoom
Facetime
How would you like to receive your invoice?
Digital Invoice by Email
Paper Invoice by Mail
Notes
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Policies
Please check the policies below to confirm that they have been read and understood.
For weekly students, monthly payments are due on the day of the first lesson of the month. Invoices will be provided 7 days prior to the due date. For one-time or project based students, payments are due anytime before the scheduled lesson. Any returned/bounced checks will be charged a $25 reprocessing fee in addition to the amount due. Please make checks payable to Zach or Ginny Shockley. Venmo payments can be made to @ShockleyMT. A 20% late fee will be charged for payments that are more than 24 hours late. WEEKLY STUDENTS: Most months will only contain 4 lessons, but some months will have 5 lessons. If you choose to receive an invoice, you will receive a reminder for months with 5 lesson days. Monthly 5-Lesson Prices will be as follows: 30 MINUTE LESSON ($150), 60 MINUTE LESSON ($300). Otherwise, regular 4-Lesson monthly tuition will be as follows: 30 MINUTE LESSON ($120), 60 MINUTE LESSON ($240).
If you cannot attend a scheduled lesson, please notify the instructor via email at least 24 hours in advance. If you do not notify the instructor in advance and do not show up, you will be charged the cost of the lesson. If you have an emergency or illness and need to cancel the day of class, please email the instructor at shockleyperformingarts@gmail.com. Missed lessons with advance notice will be rescheduled at no additional cost to occur within 30 days of the missed lesson. If the instructor needs to cancel a lesson for any reason, you will be notified at least 24 hours in advance and a makeup will be scheduled at no additional charge. No deductions will be made for missed classes.
There will be no lessons held on the following holidays. Makeup lessons for these weeks will be rescheduled at no additional charge. 2021 Holidays: November 25th - November 28th THANKSGIVING / December 24th - January 2nd HOLIDAY BREAK
Weekly students may withdraw at any time with 1 month notice prior to withdrawing. Withdrawal must be done in writing through email. Any unused makeup lessons from before the date of withdrawal notice may be rescheduled; they may not be used as any part of the 30 day withdrawal period. Makeup lessons will not be refunded if not rescheduled prior to withdrawal.
The instructor is hereby granted permission to take photographs or video of the students to use in promotional materials.
Signature
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Lesson Goals
What are your main goals for your lessons?
What are your favorite singers, bands, musicals, genres, etc?
Anything else you would like us to know?
Submit
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