Coda Community Music Lesson Registration Form
This registration form is for private music lessons with Coda Mountain Academy teachers. The lessons will begin the week of January 15th. Cost is $25 for a 30 minute lesson. Students can borrow a Coda instrument for free as needed, depending on availability. Lessons will take place at the Coda Center, 2855 Maple Avenue, Fayetteville, WV 25840. If you have any questions, you can contact us by email at firstname.lastname@example.org, or by phone/text at (304) 900-0096.
Parent/Guardian 1/Adult Student
Parent/Guardian 1/Adult Student Phone Number
Please enter a valid phone number.
Parent/Guardian 2 Phone Number
Please enter a valid phone number.
Street Address Line 2
State / Province
Postal / Zip Code
Which instrument does your student want to take lessons on?
What is your student's level of skill on their chosen instrument?
Has had private lessons before
Does the student need a Coda loaned instrument?
Student NEEDS to borrow a Coda instrument
Student HAS their own instrument
Student already HAS a Coda loaned instrument
Which of the following days/times would work best for your schedule? Select your top three choices. A Coda representative will contact you to confirm an exact time for your lesson.
Monday 10:00 AM - 12:00 PM
Monday 6:30 PM - 8:30 PM
Tuesday 11:30 AM - 1:00 PM
Thursday 6:30 PM - 8:30 PM
Terms & Policies
Loaned Instrument Policy: Our musical instrument distribution system is designed to meet the needs of students within Coda Mountain Academy. When registering for lessons, a student can request to borrow an instrument from Coda. Instruments are loaned to students as needed on a first-come basis. Should a student need to borrow an instrument, a labeled instrument will be loaned to the student and a record will be made to identify which instrument is borrowed. While it is free to borrow an instrument, it is required that the instrument be well cared for and returned at the end of each semester in the same condition it was loaned. Failure to properly take care of the Coda loaned instrument and return it at the end of the semester, unless explained and agreed upon by Coda administration, may result in a fine equivalent to the cost of the loaned instrument or the cost of repairs.
I have read and agree to the above stated policy
Attendance Policy: Regular attendance is important for students to make progress. Students are expected to give their teacher at least 24 hours advance notice if they are going to miss a lesson. Lesson time will not be extended for late arrivals. Teachers are not required to schedule make-up lessons for any lessons that a student misses or cancels. If a teacher has to cancel a lesson for any reason, he/she will schedule a make-up lesson.
I understand the attendance policy and will give at least 24 hours advance notice if I have to cancel my/my child's lesson. I understand that teachers do not have to schedule make-up lessons for any lessons that I cancel or miss.
Payment Policy: Payment for lessons is on a monthly basis and is due at the first lesson of each month. You will submit payment directly to your teacher. If lesson fees are not paid at the first lesson, the teacher may charge a late fee of $5 per week that the payment is late.
I understand that lesson fees are due monthly, and I will be expected to pay the fee at the first lesson of each month, or may have to pay a late fee if I do not pay on time.
Photo Waiver: Understanding that Coda photos and videos are important to promote public awareness, access future scholarship funding and reach more youth, I hereby consent for my child (or myself if 18 or older) to be photographed and/or videoed for Coda Mountain Academy. The resulting photographs or videos may be subsequently used without compensation to me by Coda Mountain Academy, or third parties for publications (including web sites), advertising, Facebook and/or publicity purposes at the discretion of Coda Mountain Academy. Some photos and videos will be used in the year end grant report. I waive the right to inspect or approve the finished photograph, video and/or publication use.
I, parent/guardian/self (if over 18), consent to the above stated photo/video waiver for Coda.
I, parent/guardian/self (if over 18), DO NOT consent to the above stated photo/video waiver for Coda.
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