Art with Love Music Lessons Enrollment

Art with Love Music Lessons Enrollment

Register for music classes and provide necessary consents
Student Information

Please provide details about the student enrolling.
Student Full Name

First NameLast Name
Student's School Name
Student Date of Birth

MonthDayYear
Date
Name of School
Parent/Guardian Information

Contact details for the parent or legal guardian.
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Parent/Guardian Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Information

Provide an emergency contact (other than parent/guardian).
Emergency Contact Full Name

First NameLast Name
Emergency Contact Relationship to Student
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information, Allergies & Diagnosis.

Please indicate if your child has: • Any medical conditions • Any allergies • Any developmental, behavioral, or learning diagnosis • Any special accommodations needed
List any medical conditions, allergies & diagnosis.
Will you be using the Step Up for Students scholarship to pay for these lessons?
Select your program
Step Up for Students Scholarship .If you plan to use the Step Up for Students scholarship to pay for lessons:

• Please complete this registration form.

• Do NOT complete payment through this form.

• You must contact Art with Love directly before scheduling services.

• All payments must be processed through the Step Up for Students portal once services are approved.

Please contact us before processing any Step Up payment.

Email: artwithlove.academy@gmail.com
Phone: 786-223-1884
How many classes per week would you like?
Where will the lessons take place?
Liability Waiver Agreement
I, the undersigned parent or legal guardian, understand that participation in music lessons and activities with Art with Love may involve the use of musical instruments and physical movement. While every effort is made to provide a safe learning environment, I acknowledge that minor injuries may occur during lessons or activities. I voluntarily assume full responsibility for any risk of injury, loss, or damage associated with participation in lessons held at home, school, or any designated location. I hereby release and hold harmless Art with Love, its instructors, and representatives from any liability, claims, or demands arising from participation in the program, except in cases of gross negligence.
I agree to the Liability Waiver
Enrollment Terms & Policies
By enrolling in Art with Love programs, I agree to the following policies:

• Tuition payments are required to secure enrollment.
• Payments are non-refundable once processed.
• Missed lessons require 3-hour notice to qualify for rescheduling.
• Late arrivals may result in shortened lesson time.
• Monthly programs must be paid in advance.
• Step Up scholarship payments must follow Step Up guidelines and approval procedures.

I understand that failure to comply with these policies may result in cancellation of services.

Program Cancellation

Parents who wish to discontinue lessons must notify Art with Love at least 7 days in advance.

If proper notice is not provided, the upcoming scheduled lesson or monthly payment may still be charged.

I agree to the Terms & Policies
Photo/Media Consent
Parent/Guardian E-Signature
Should be Empty:

Art with Love Music Lessons Enrollment

Student Information

Parent/Guardian Information

Emergency Contact Information

Medical Information, Allergies & Diagnosis.