Summer Lessons Registration Form Jessica Stamey, Piano 2021
SSA does not discriminate on the basis of race, sex, creed, national or ethnic origin, disability, or socioeconomic status. Please fill out the form completely.
Student Name
*
First Name
Last Name
Parent Name
First Name
Last Name
Current Suzuki School of the Arts Student?
*
Yes
No
Student Age
Current Piece
Student Instrument
Piano
Preferred Phone Number
*
-
Area Code
Phone Number
Preferred Email Address
*
example@example.com
Jessica Stamey, Piano
Jessica will contact you before your lesson to schedule a specific day and time. Her contact information is: cell 704 473 4086, and email jessica.r.stamey@gmail.com
Jessica Stamey Available Dates
Lesson
Lesson minutes Length
Information we need to know?
May 31-June 4
30
45
60
June 7-11
30
45
60
June 14-18
30
45
60
June 28-July 2
30
45
60
July 5-9
30
45
60
July 12-16
30
45
60
July 19-23
30
45
60
July 26-30
30
45
60
August 2-6
30
45
60
August 16-20
30
45
60
August 23-27
30
45
60
Total Amount Owed
Financial Obligation
I understand that my financial obligation to Suzuki School of the Arts is for the entire amount that I sign up for on this form. I agree to pay my summer lessons tuition in full and before the first lesson. Should I need a payment plan I will contact the Executive Director. I understand that if I default on my summer lessons payment, lessons will be discontinued and my debt will be sent on to a collection agency for payment.
Preferred Method of Payment
Cash
Check
PayPal Invoice
Checks are to be made payable to Suzuki School and can be mailed to PO Box 3589 Hickory NC 28603
Anything we need to know?
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New Student Information Form
Thank you for your interest in our program! We need some additional details from you in order to have the best start with lessons.
Student Name
First Name
Last Name
Level of experience on instrument? (Beginner, etc)
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: