Current Student Summer Registration

STUDENT NAME: *

Desired Lesson Day: Instrument 2, Choice 1:

Primary Contact Name: *

Parent/ Guardian or Adult Signature *

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.

Desired Time: Instrument 2, Choice 1:

Desired Lesson Day: Instrument 2, Choice 2:

First Instrument: *

Email Address: *

Desired Time-Frame: Instrument 1, Choice 2 *

Teacher Preference for Instrument 2:

Teacher Preference for Instrument 1: *

Desired Time Frame: Instrument 2, Choice 2:

Comments/ Questions:

Second Instrument:

Lesson Length for Second Instrument

Desired Time Frame: Instrument 1, Choice 1 *

Lesson Length *

Comments:

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. *

Desired Lesson Day: Instrument 1, Choice 1 *

Desired Lesson Day: Instrument 1, Choice 2 *

current Student summer registration