Emergency Contact Phone *

Parent/ Guardian or Adult Signature *

I give permision 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 *

How Many Lesson Weeks Will You Attend? *

Preferred Form of Billing *

New Student Online summer registration

Emergency Contact Name *

Primary Contact Name: *

Email: *

Desired Schedule *

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. 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.

Address *

Teacher Preference

Date of Birth *

Secondary Contact Phone

Desired Schedule for Second Instrument

Primary Contact Phone *

Private Lesson Options

Summer Session:

July 9 - Aug 22

Tuesday 1:00 - 8:00

Wednesday 1:00 - 8:00

Thursday 1:00 - 8:00

INSTRUMENT

Piano: age 4.5 - adult
Violin: age 5 - adult

Ukulele: age 5 - adult
Guitar/Bass: age 6 - adult Voice: age 10 - adult

LESSON LENGTH

1/2 hour ($35 per lesson)

3/4 hour ($52.50 per lesson)

1 hour ($70 per lesson)

SUMMER TUITION:
JULY AND AUGUST ARE PRE-PAID IN FULL PRIOR TO THE FIRST LESSON

Music 101 accepts payments by personal check or cash only.

Music 101 will be closed the following weeks:

June 29 - July 8, 2019

August 23 - September 2, 2019

Fall 2019 begins Tuesday, September 3, 2019

Secondary Contact Name:

Teacher Preference

Online Student Registration Form

Please submit 1 form per student

Second Instrument

STUDENT INFORMATION *

Lesson Length for Second Instrument

INSTRUMENT *