Nan Freeman 2022 Academic Year Reg

Academic Year Registration Form 2022-2023 for Nan Freeman's Studio

Please fill in the form below completely. If you have questions please call 828 322 2694 or email hickorysuzukischool@gmail.com.
Suzuki School of the Arts is a 501 (C) 3 non profit organization that does not discriminate on the basis of race, sex, creed, national or ethnic origin, disability, or socioeconomic status.
Student Name *

First Name Last Name
Parent Name only if student is younger than 18

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Number

Area Code Phone Number
Cell Number *

Area Code Phone Number
E-mail *
Student Age *
Student Birthdate *

Month Day Year
Date
Student School and Grade Level
Lesson information
Student Instrument *
Violin/Viola/Cello
Lesson Length *
Preferred Lesson Time 1 *
ex Monday at 7pm
Preferred Lesson Time 2 *
ex Tuesday at 4pm
Preferred Lesson Time 3
ex Friday at 5pm
Lesson Schedules will be made on a first come basis. Teachers will contact students before classes begin.
Is there anything we should know?
Participation Agreement *

I understand that participation in all private lessons, group lessons, workshops, concerts and other events will ensure the optimum success and and progress. Therefore I will make every effort to attend and participate in all activities of the school.
Photo Release I understand that the Suzuki School of the Arts may photograph and/or videotape any SSA function or event which my family attends. *

I hereby grant SSA my permission to use such photos or videos for educational, historical, or publicity purposes. I DO NOT grant permission to use photos/videos containing me or my child for educational, historical or publicity purposes.
Additional Information

This gives us information about our community for recruiting members of our Board of Directors and grant information.
Mother Name

First Name Last Name
Mother Occupation
Mother Work Phone

Area Code Phone Number
Father Name

First Name Last Name
Father Occupation
Father Work Phone

Area Code Phone Number
Any additional information we need to know?
Payment information

Payment is due before the first lesson, please email hickorysuzukischool@gmail.com if you have questions about tuition prices.
Name of Person Financially responsible for lessons *

First Name Last Name
Phone number if different from above

Area Code Phone Number
Email if different from above
example@example.com
Payment options *
Choose one please
Payment method *
Please choose one;
An invoice with your individual bill will be sent to you within 2 weeks.

Checks should be made out to SSA and sent to PO Box 3589, Hickory, NC 28603. Suzuki School accepts credit cards through PayPal and you will receive an email invoice including a 3% processing fee.
Registration Fee *

I understand that my financial obligation to Suzuki School of the Arts will include a $10.00 per family registration fee, due with the first payment.
Financial Agreement *

Financial Obligation I understand that my financial obligation to Suzuki School of the Arts is for the entire academic year, September through May. Should lessons be discontinued during that time, I agree to pay my tuition in full. I understand that if I default on my tuition payments, lessons will be discontinued and my bad debt will be sent on to a collection agency for payment.
Agreeing to the provisions of this Enrollment Contract constitutes a legally binding agreement between you and Suzuki School of the Arts.
Signature *

Clear
I would like to make a tax-deductible donation to help provide scholarships and other needed items not covered through tuition.

I will send a check Please bill me through PayPal
Amount of donation: $Please send check to SSA, PO Box 3589, Hickory, NC 28603
Should be Empty:

Academic Year Registration Form 2022-2023 for Nan Freeman's Studio

Lesson information

Additional Information

Payment information