Student Enrollment Form

Student Enrollment Form

Fill in your details, Agree to the Terms and Conditions, Sign, Choose Payment Type for "Term Fee" only and Complete Payment, then Hit "Submit Enrollment".
The red * means the field is required before submitting the form.
Student Full Name

First NameLast Name
Student Age
Student Grade Level
Parent/Guardian Name (if student is under 18)

First NameLast Name
Primary Parent/Guardian Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Instrument or Class Type
Preferred Lesson Days (Check all that apply)
Preferred Lesson Times & Comments
Preferred Lesson Duration (Voice Lessons MUST be at least 45 minutes or more, Vocal Therapy MUST be at least 1 hour in length to begin with)
Previous Piano Experience
Previous Vocal Experience
Goals for Music Lessons (Include Music preferences/ styles/genres)
Name of other drivers dropping off/picking up:

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of other drivers dropping off/picking up:

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies or Special Needs
Type N/A if Not Applicable
Future Classes you might be interested in
Terms and Conditions

By submitting this form, you acknowledge the studio’s policies, agree that enrollment is subject to approval, and understand that lessons begin only after the form is completed, signed, and any required payment is received.

Liability / Hold Harmless

You understand that music instruction involves some risk and agree that Selah Music Studio and Michelle Smith are not responsible for injuries, losses, or damages except where required by law. Please review the full liability waiver and studio policies before signing.

Payment

Tuition is due in advance according to the selected payment option. Late payments may result in a fee. Missed lessons, cancellations, and rescheduling must follow studio policies.

Safety and Conduct

The studio may decline or end enrollment if safety, conduct, or policy concerns arise.

Acknowledgment

By signing and submitting this form, you confirm that you have read, understood, and agree to these terms.

Selah Music Studio has the full detailed Terms and Conditions along with the Liability Waiver and all Policies and Guidelines on the website at www.selahmusicstudio.com for viewing or they can request a copy by emailing Selah Music Studio at selahmusicstudio98@gmail.com.
Agreement of the Student or Parent/Guardian
Signature of Student or Parent/Guardian (if under 18)

Once signed SELECT PAYMENT CHOICE BELOW to pay $25 "Term Fee" BEFORE SUBMITTING. QR codes included.
Select Payment Choice: (Pay $25 per family "Term Fee")
Scan the QR below to pay via Venmo

Please be sure to list the students name in the memo/note box.
Scan the QR code below to pay via PayPal

Please be sure to list the students name in the memo/note box.
Scan the QR Code below to pay via CashApp

Please be sure to list the students name in the memo/note box.
Scan the QR code below to pay via Zelle

or Open your Zelle mobile app or your online banking

and use my Zelle information: (636) 584-1476

Please be sure to list the students name in the memo/note box.
Should be Empty:

Student Enrollment Form

Scan the QR below to pay via Venmo

Scan the QR code below to pay via PayPal

Scan the QR Code below to pay via CashApp

Scan the QR code below to pay via Zelle

or Open your Zelle mobile app or your online banking

and use my Zelle information: (636) 584-1476