Jessica Stamey 2025-2026Academic Year Reg

Academic Year Registration Form 2025 - 2026 for Jessica Stamey's Studio

Please fill in the form below completely. If you have questions please 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 NameLast Name
Parent Name only if student is younger than 18

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Number

Area CodePhone Number
Cell Number*

Area CodePhone Number
E-mail*
Student Age*
Student Birthdate*

MonthDayYear
Date
Student School and Grade Level
Lesson information
Student Instrument*
Piano/Voice
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
Is there anything we should know?
Lessons will be scheduled on a first come basis. The teacher will contact students before classes begin to confirm their lesson time.
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 NameLast Name
Mother Occupation
Mother Work Phone

Area CodePhone Number
Father Name

First NameLast Name
Father Occupation
Father Work Phone

Area CodePhone 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 NameLast Name
Phone number if different from above

Area CodePhone Number
Email if different from above
example@example.com
Payment options*
Choose one please
Payment method*
Please choose one
An invoice will be sent to you within two weeks of registering.

Checks should be made out to SSA and sent to PO Box 3589, Hickory, NC 28603. Suzuki School accepts credit cards through Quickbooks Pay 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 $25.00 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 program items not covered by tuition.
Amount of Donation $ blanks
Please make checks to SSA and mail to PO Box 3589, Hickory, NC 28603.
Should be Empty:

Academic Year Registration Form 2025 - 2026 for Jessica Stamey's Studio

Lesson information

Additional Information

Payment information