Music Lover's Student Registration Form

Music Lover's Student Registration Form
Date *

Month Day Year
Date
Name of Student *

First Name Last Name
Birthdate *

Month Day Year
Date
Best Contact Number *
Please enter a valid phone number.
Preferred Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are you a parent or guardian registering a minor under the age of 18? *

Yes (continue to Section 1) No (skip to section 2)
SECTION 1

Parent Contact and School Information
Child's Name

First Name Last Name
School:
Grade:
Parent 1 Name

First Name Last Name
Cell Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Email
example@example.com
Parent 2 Name (if applicable)

First Name Last Name
Cell Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Email:
example@example.com
SECTION 2

Emergency Contact and Health Information
Emergency Contact *

First Name Last Name
Relationship *
Phone Number *
Please enter a valid phone number.
Do you have any food allergies? *
If yes, please list them here: *
Do you have any other health conditions we should know about? *
If yes, please list them here: *
SECTION 3

General Registration and Music Background Information
How did you hear about Music Lover's *

Referral Drive By Internet Search Social Media Lessons.com Other
Do you have formal or informal experience singing or playing a musical instrument? *

Yes No
If yes, what instrument (including voice)do you play?blanks
Have you had music lessons before? *

Yes No
If yes, how long did you take lessons? blanks years blank months.
Desired Start Date: *

Month Day Year
Date
Instrument or Class Subject *

Voice Guitar Bass Guitar Piano Drum Set Congas/Latin Percussion Songwriting Music Theory Violin Viola Cello
Lesson Day *

Monday Tuesday Wednesday Thursday Friday Saturday
Lesson Time *

Hour Minutes

AM/PM Option
Lesson Duration *

30 minutes 60 minutes
SECTION 4

Media Release Form for Internet, Website, and Social Media
I give Music Lover's my permission to post photographs, videos, and images of myself or my child in the following areas: (Check all that apply) *

Music Lover's website Any Social Media Platforms (including but not limited to Facebook, Twitter, Instagram, YouTube) I do not wish for Music Lover's to post about me or my child on any internet or social media platforms.
I give Music Lover's permission to feature/highlight myself or my child on their website or social media in the form of a blog, interview, or article. *

Yes No
I give permission for Music Lover's Learning Center to use photographs, videos, and images of myself or my child under the following conditions: *
I agree and understand that I will not receive any financial renumeration for my own or my child's media appearances and hereby release Music Lover's Learning Center and it's employees and contract workers from any future claims as well as the liability arising from the use of any photograph, interview, video recording. *

Yes, I understand and agree to to above terms.
I affirm that I have agreed to the conditions listed above regarding using my image on the internet, the Music Lover's website, and social media as I indicated in my answer choices above. I also affirm that if I am filling this form out for a minor under the age of 18, that I am the parent or legal guardian of the child, and have the ability to give consent and authorize the signature below for this media release on their behalf.

If in the event that I need to make a change in this media release agreement, Music Lover's will send another form at my request so that I can make the necessary adjustments and changes from the original one that I am signing today.
Signature *

Clear
Date *

Month Day Year
Date
SECTION 5

Music Lover's Policies and Procedures Agreement and Signature
I have read and understand the attached Music Lover's School Policies & Procedures, and agree to abide by the 12 policies that are outlined in the document provided below. This also includes, but is not limited to all registration, late fees, lesson cancellations, and the required 30 day notice to terminate lessons.

Although music lessons are currently offered online, the in studio policies and procedures will be applicable in the event that Music Lover's offers in person or face to face lessons either during or after the COVID-19 worldwide pandemic.

If I am able to elect in person or face to face lessons as an option during the COVID-19 pandemic, I understand that I will need to read, sign, and agree to the Music Lover's Family Pledge and COVID 19 Liability Release and Waiver in addition to submitting the Student COVID-19 Health Form for every lesson in order to physically enter the music studio for musical instruction.
Signature of Parent or Adult Student *

Clear
Date *

Month Day Year
Date
SCHOOL POLICIES AND PROCEDURES

1. There is an annual renewable $25.00 Registration Fee for all students. For families with multiple students, the registration fee is $15.00 for each additional family member enrolled after the initial $25.00 registration has been paid.

2. Tuition is determined by the number of lessons each month multiplied by the amount of tuition per lesson. In the event that there are 5 lessons during a month, please make the proper adjustment when paying tuition for that month.

3. A $15.00 late fee will be charged if the tuition payment is received after the 10th of the month.

4. A $25.00 fee will be charged for returned checks.

5. Please inform the instructor in advance if the student will not be able to arrive on time for his or

her private lesson. It is also the students responsibility to notify the instructor in advance if he or she must miss a lesson and make arrangements for a make up lesson.

6.Should the teacher need to be absent, the teacher will notify the student and schedule a make up lesson.

7. Any student who misses or cancels four or more lessons consecutively without notice will be considered withdrawn from the school. Music Lover's will not hold the student's reserved lesson time and instructor. If the student wishes to continue, he or she will need to re- enroll. Student is still liable for all tuition and fees up until the time of withdrawal fro the school.

8. If the student decides to discontinue private lessons, Music Lover's and the teacher must be informed at least 30 days in advance. Music Lover's will not refund any tuition or registration fee.

9. Please be respectful of the Music Lover's waiting area. No food or drinks are allowed with the exception of water.

10. Parents are responsible for the supervision of their children and guests while on the premises of Music Lover's. Parents are held responsible for any injuries to their children and guests under their watch and for any damages to the property or equipment at Music Lover's.

11. Parents, legal guardians of minor students and adult students waive the right to any legal action for any injury sustained on school property resulting from normal activity or any other activity conducted by the students before, during, or after class time.

12. Neither Music Lover's or its instructors provide before or after class supervision for students. Students are not to be left at the school for excessive times before or after class.
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform