New Student Summer Registration

Lesson Length *

Teacher Preference for Instrument 2:

I give permission to Music 101 to photograph and audio/video record classes, lessons and other activities, to be used in print or electronic promotions. Music 101 will not publish the names of students without parental consent *

Secondary Contact Name:

Emergency Contact Name *

Primary Contact Phone Number: *

Desired Time Frame: Instrument 2, Choice 2:

Desired Time-Frame: Instrument 1, Choice 2 *

Desired Lesson Day: Instrument 2, Choice 2:

STUDENT NAME: *

Emergency Contact Phone Number: *

Lesson Length for Second Instrument

Desired Lesson Day: Instrument 2, Choice 1:

Primary Contact Name: *

Lesson Format: VIRTUAL; Please select the weeks you will attend Virtually: *

July 27, 28, 29

August 3, 4, 5

August 10, 11, 12

August 17, 18, 19

None

Lesson Format Instrument 2: IN-PERSON; Please select the weeks you will attend At The Studio:

July 27, 28, 29

August 3, 4, 5

August 10, 11, 12

August 17, 18, 19

None

Comments:

Comments/ Questions:

First Instrument: *

Music 101 POLICY ACKNOWLEDGEMENT *

In checking this box, I (parent/guardian or adult student) understand the following Summer Lesson Policies: There are no make‑up lessons or refunds for student absences. Any missed time by the student due to tardiness will not be made‑up or refunded. If choosing in-person lessons, Music 101 reserves the right to send students home who fail to comply with safety policies. By signing, I am willing to comply with the established guidelines. Summer tuition is to be paid by cash or check in order to reserve the agreed upon lesson time.

Birthdate *

Teacher Preference for Instrument 1: *

SECOND INSTRUMENT:

Desired Time: Instrument 2, Choice 1:

Parent/ Guardian or Adult Signature *

Email Address: *

Secondary Contact Phone Number:

Desired Lesson Day: Instrument 1, Choice 1 *

Prior Experience:

Desired Time Frame: Instrument 1, Choice 1 *

Lesson Format: IN-PERSON; Please select the weeks you will attend At The Studio: *

July 27, 28, 29

August 3, 4, 5

August 10, 11, 12

August 17, 18, 19

None

Desired Lesson Day: Instrument 1, Choice 2 *

Lesson Format Instrument 2: VIRTUAL; Please select the weeks you will attend Virtually:

July 27, 28, 29

August 3, 4, 5

August 10, 11, 12

August 17, 18, 19

None

Address: *

New Student summer registration