Student Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
School Grade Grade Current School School
Instrument Instrument Length of previous study of instrument Length of Study
Private Lessons:

Length = 30 minutes $160.00 per monthLength = 45 minutes $240.00 per monthLength = 60 minutes $320.00 per monthPartner Lesson: Length = 45 minutes $125.00 per month, per student
Group Classes

45 minutes in length (minimum of 4 students) $100.00 per month
Father's Name Name Email email Cell Cell
Mother's Name Name Email Email Cell Cell
Emergency Contact Name Name Phone (If other than parent) Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Photo and Video Release: Does the instructor have permission to feature photos and / or videos of your child (never using full last name) on the studio website, Facebook page, and/or promotional items?

YesNoPlease ask on a case-by-case basis
Additional Comments
Have you read and understand the Kawai Music School Policy?

YesNo
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: