No Parent | PA Suzuki Institute Student Registration Form 2025

Suzuki Student Registration Form

Student Name*

1-First Name1-Last Name
Student Age (On July 1, 2025)*
Instrument*
Current Suzuki Book*
Current Working Piece*
Parent Name*

P1-First NameP1-Last Name
Other Parent/Guardian (if applicable)

P2-First NameP2-Last Name
Phone Number*

Area CodePhone Number
Emergency Phone Number (if different)

Area CodePhone Number
Parent Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the participant have any allergies or medical conditions that we should be made aware? If yes, please give details.
Teacher Name

Teacher First NameTeacher Last Name
Teacher Email
example@example.com
My child plans to perform on a student recital*
My child will require a piano accompanist for his/her solo piece
Registration Fee (per family). Determined by date you submit this form and we receive your payment. *
Course I am registering for (Includes daily lunch and enrichment courses)*
ARTS AND CRAFTSFIDDLING (VIOLIN AND VIOLA Bk2+)VISUAL ARTMusic Theory/Composition
ARTS AND CRAFTSFIDDLING (VIOLIN AND VIOLA BK2+)VISUAL ARTMusic Theory/Composition

1 Free T-Shirt for each participant. Please pick Size(s) **(T-Shirts no longer available)

Rows	Child S	Child M	Child L	Adult S	Adult M	Adult L	Adult XL
How many of each wanted size

Student2 Name

2-First Name2-Last Name
Student2 Age (On July 1, 2025)
Instrument2
Current2 Suzuki Book
Current2 Working Piece
Does the participant(2) have any allergies or medical conditions that we should be made aware? If yes, please give details.
Teacher2 Name

First Name2Last Name2
Teacher2 Email
example@example.com
My child2 plans to perform at a student recital
My child2 will require a piano accompanist for his/her solo piece
Course2 I am registering for (Includes daily lunch and enrichment courses)
ARTS AND CRAFTSFIDDLING (VIOLIN AND VIOLA Bk2+)VISUAL ARTMusic Theory/Composition
ARTS AND CRAFTSFIDDLING (VIOLIN AND VIOLA Bk2+)VISUAL ARTMusic Theory/Composition

Student3 Name

3-First Name3-Last Name
Student3 Age (On July 1, 2025)
Instrument3
Current3 Suzuki Book
Current3 Working Piece
Does the participant(3) have any allergies or medical conditions that we should be made aware? If yes, please give details.
Teacher3 Name

First Name3Last Name3
Teacher3 Email
example@example.com
My child3 plans to perform on a student recital
My child3 will require a piano accompanist for his/her solo piece
Course3 I am registering for (Includes daily lunch and enrichment courses)
ARTS AND CRAFTSFIDDLING (VIOLIN AND VIOLA Bk2+)VISUAL ARTMusic Theory/Composition
ARTS AND CRAFTSFIDDLING (VIOLIN AND VIOLA Bk2+)VISUAL ARTMusic Theory/Composition

Student4 Name

4-First Name4-Last Name
Student4 Age (On July 1, 2025)
Instrument4
Current4 Suzuki Book
Current4 Working Piece
Does the participant have any allergies or medical conditions that we should be made aware? If yes, please give details.
Teacher4 Name

First Name4Last Name4
Teacher4 Email
example@example.com
My child4 plans to perform on a student recital
My child4 will require a piano accompanist for his/her solo piece
Course4 I am registering for (Includes daily lunch and enrichment courses)
ARTS AND CRAFTSFIDDLING (VIOLIN AND VIOLA Bk2+)VISUAL ARTMusic Theory/Composition
ARTS AND CRAFTSFIDDLING (VIOLIN AND VIOLA Bk2+)VISUAL ARTMusic Theory/Composition

Total Amount Due (Includes 3% credit card transaction fee)
*Please note that registration is NOT complete until payment is received
Questions, Comments
By pushing submit I hereby acknowledge that the information provided above is true and correct to the best of my knowledge. I also agree to the terms listed below

In consideration of the use of premises or facilities owned or operated by Moravian University and/or in consideration of permitting me/my minor child to participate in the camps, on behalf of myself, my minor child, my heirs, executors, administrators, successors, or assigns I hereby release and forever discharge Moravian University, its agents, servants, and employees of and from any and all manner of actions, causes of action, suits, damages, claims, and demands, on account of personal injury, including death, or any other cause whatsoever, which I may have against them by reason of or arising out of me/my minor child’s participation in the above-listed activity. I authorize Moravian University to use me/my minor child name or image broadcast in any news media as part of their presentations of the Pennsylvania Suzuki Institute. Such authorization includes current reproduction and future events sponsored by Moravian University Pennsylvania Suzuki Institute. Moravian University assumes no responsibility for the care, custody, or control of participant’s personal belongings including instruments.

Cancellation Policy:

100% refund (except Registration Fee and credit card transaction fee) if requested four or more weeks prior to the first day of class
50% refund (except Registration Fee and credit card transaction fee) if requested less than four weeks, up to one week prior to the first day of class
No refunds if requested one week prior to the first day of class
Full refunds will be issued if course is cancelled by Institute (except credit card transaction fee)
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