Moscow Music Academy™ Enrollment/Consent Form

Moscow Music Academy™ Enrollment/Consent Form
872 Troy Rd, Ste 170, Moscow ID 83843 ~ MoscowMusicAcademy.com ~ 208-882-6733
Lesson Day
Please note: MMA is not open for lessons on Sunday
Lesson Time

Hour Minutes

AM/PM Option
Instrument/Lesson Type*
Piano • Ukulele • Guitar • Drums • Voice • Violin/Fiddle • Saxophone • Kids Rock Band (ages 4-5) • Other_________________
Lesson Length*
30 min weekly private lessons are $116/mo, 60 min weekly private lessons are $232/mo All classes: 45 minute weekly are $116/mo per enrolled student
Student First and Last Name*
Student First and Last Name*

First NameLast Name
Student D.O.B*

MonthDayYear
Date
Parents/Guardians Names*
Address*

Address

Street Address Line 2

CityState

Zip
Home/Cell Phone Number*
Please enter a valid phone number.
Work/Emerg. Phone (Adult name/Number)*
Please enter a valid phone number.
Parent/Adult Student Primary Email*
example@example.com
Please tell us how you heard about Moscow Music Academy*
Payment & Attendance Policies

REGISTRATION: A completed and signed enrollment/consent and payment authorization form is required to secure a lesson day and time with an instructor at the Moscow Music Academy. A $25 registration per student ($40 per 2 in a family) is due at the time of registration to reserve your lesson slot with a professional music teacher and also includes your welcome packet, student assignment book and other academy programs, and is non-refundable. There is a One Month minimum for all lessons. Please review and initial each part below.
TUITION PAYMENT & FEES NEW STUDENT: Tuition is due at the time of registration to reserve your lesson time. Lessons are $116 per month for weekly 30 minute sessions, $232 per month for weekly 60 minute sessions. No lesson times will be reserved or conducted without receipt of payment. Tuition will be prorated the starting month only if the student enrolls after the first week of the month and there are less than 4 lesson weeks remaining that month. Thereafter, Tuition is due in full by the 16th of the month to secure the students slot for the following month and is payable by auto billing. A late fee of $25 will be assessed for delayed payments. Payment not received by the 10th of the month will result in student being dropped from the schedule. All NSF and/or declined transactions will be charged a $25 fee to cover bank merchant charges to our account. PLEASE NOTE: Tuition is set at a flat monthly rate based on 48 lesson weeks held throughout the calendar year. You are NOT charged tuition for holiday closures.
Initial*

Clear
STUDENT CANCELLATIONS: I understand that cancellations or absences by the student can NOT be rescheduled, or refunded/credited for any reason.
Initial*

Clear
MISSED LESSONS, MAKE-UP LESSONS & LATE ARRIVALS: STUDENT- If you have to miss a lesson, your teacher can provide a customized makeup video lesson at your request on your LessonMate student page! Similar to your regular lesson, it will entail a review of last weeks lesson as well any new concepts to work on for the week ahead. You'll receive an email notice letting you know that your make up lesson is ready and waiting for you! TEACHER - For any lessons missed by the teacher, we will provide a qualified Guest Teacher from our teaching staff. If a Guest Teacher is unavailable, a personal make up lesson with your teacher will be scheduled promptly.
Initial*

Clear
DISCONTINUING LESSONS: To discontinue lessons and charges to your account, a completed withdrawal form must be turned in at the Studio BEFORE the 15th of your last month. We do not pro-rate tuition for the last month's lessons. Students will be responsible for their last month's tuition whether or not they attend lessons. Withdrawal forms received on the 16th day of the month or later will become effective for the following 15th of the month withdrawal deadline.
Initial*

Clear
PHOTO RELEASE: MMA is hereby granted permission to take/use photos of students for promotional materials
Initial*

Clear
AGENCY. Students and Parents understand that Teacher is an independent contractor and is not an agent of MMA. MMA is not bound by any representations made by Teacher. If you have any questions regarding specific music lesson content, discuss this with your Teacher. Any other questions regarding lessons such as Academy scheduling & events, billing etc. contact MMA adminstrative staff.
Signature of Parent/Guardian or Student if over 18:*

Clear
Today's Date*

MonthDayYear
Please check your email for a copy of your registration form.
Thank you for choosing Moscow Music Academy as
your music lesson provider!
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Moscow Music Academy™ Enrollment/Consent Form

Payment & Attendance Policies