Student Enrollment Form
Completion time: 8-10min
Student Information
Name
*
First Name
Last Name
Parent Name (if under 18)
Student Gender
*
Please Select
Male
Female
N/A
Email
*
example@example.com (please enter an email that may serve as contact for studio notices and invoices)
Contact Phone Number
*
Format: (000) 000-0000.
Student Date of Birth
*
/
Month
/
Day
Year
Date
Is there any health or learning diagnosis I should know about?
i.e. Autism, Asthma, ADHD, Dyslexia, etc.
Do you have any experience in music?
(i.e. played in orchestra, another instrument for x amount of years, etc.)
Emergency Contact Info
Is the information filled above the same as the emergency info?
*
Yes
No (please fill out emergency info)
Full Name
Relationship to The Student
*
Phone Number
Leave blank if same phone number as Contact
Format: (000) 000-0000.
Lesson Preferences and Instrument
Instrument
*
Please Select
Violin
Viola
Cello
Undecided
Do you already own/rent an instrument?
*
Please Select
Yes
No
Send me options
What are your lesson goals?
Music History
Music reading & theory
Audition and performance preparation (All-State, Harrison, Competitions, etc.)
Overcoming fear, self doubt, or other barriers in performance
Finding flow, fun, and joy while I play
Not sure (going with the flow)
Other
Lesson time length
*
Please Select
30 minutes
45 minutes
60 minutes
Check Lesson Rates under our website for monthly pricing
Is there anything else you’d like me to know?
How did you hear about Pirona Studio?
*
POLICIES
Please read each clause carefully prior to accepting!
Pirona Studio has a 4-hour cancellation policy, so please let us know at least 4 hours before your scheduled time if you need to cancel or reschedule with the exception of emergencies (proof needed). There are no refunds nor rescheduling for no-show lessons. Please remember the full rate is charged for any lesson that is canceled or rescheduled with less than 4 hours' notice.
*
I have read and agree to the 4 hour cancellation policy.
Students are entitled to 4 Make-up credits per semester and 3 during the summer. If credits have been used or the Student decides to avoid using them for a lesson, you may submit a video to the instructor in which a response and assignment will be listed for the student within 24 hours. Make-up lessons MUST be made up within 2 months of the missed date.
*
I have read and agree to the Make-Up Credit Policy
A 2-week notice is needed upon lesson withdrawal. If Student/Parent decides to withdraw before the 2-week notice, full rate will still be charged for those two weeks of lessons. This includes withdrawals done the same week as student invoice is due.
*
I have read and understand the Lesson Withdrawal policy
PHOTOGRAPHY CONSENT
I hereby grant permission to Pirona Studio to use photographs, videos, and other forms of media capturing my likeness and participation in strings activities for the following purposes: Studio promotion and student highlights, educational and instructional Materials, as well as studio Archives
*
I understand and grant Pirona Studio permission to use my photos/videos for studio promotional purposes. Only the first letter of my/my child's first name is approved to be released.
I DO NOT grant Pirona Studio permission to use my photos/videos for studio promotional purposes. I understand that even if I do not give consent, pictures containing an unidentifiable portion of my being and group photos may still be taken and used by Pirona Studio.
INVOICE AND PAYMENTS
After submitting this form, you (Student/Parent) will receive an email with your lesson invoice and enrollment fee to complete your enrollment within 12-24 hours and a link to set your card on file for monthly payments safely. Please make sure you check your email after submitting the form. Payments will be billed between the 5th day of every month. Late payments will result in a late fee of $10.
*
I understand
Student/Parent Signature
*
Submit
Should be Empty: