New Student Summer Registration

Time Preference (Choice 3)

2:30 - 4:00

4:00 - 5:30

5:30 - 7:00

7:00 - 8:00

Lesson Length *

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.

Day Preference for Second Instrument (Choice 3)

Tuesday

Wednesday

Thursday

Lesson Length for Second Instrument

Day Preference (Choice 2) *

Tuesday

Wednesday

Thursday

STUDENT NAME: *

Emergency Contact Name: *

Time Preference for Second Instrument (Choice 1)

2:30 - 4:00

4:00 - 5:30

5:30 - 7:00

7:00 - 8:00

Teacher Preference for Second Instrument (Teacher assignments are based on availability and are not guaranteed):

Day Preference (Choice 3)

Tuesday

Wednesday

Thursday

Emergency Contact Phone Number *

SECOND INSTRUMENT

Time Preference (Choice 2) *

2:30 - 4:00

4:00 - 5:30

5:30 - 7:00

7:00 - 8:00

Day Preference for Second Instrument (Choice 2)

Tuesday

Wednesday

Thursday

Secondary Contact Phone Number *

Prior Experience for Second Instrument

Secondary Contact Name: *

Time Preference (Choice 1) *

2:30 - 4:00

4:00 - 5:30

5:30 - 7:00

7:00 - 8:00

Prior Experience *

Teacher Preference for First Instrument (Teacher assignments are based on availability and are not guaranteed): *

Comments/ Questions:

Day Preference (Choice 1) *

Tuesday

Wednesday

Thursday

Parent/ Guardian or Adult Signature *

Time Preference for Second Instrument (Choice 3)

2:30 - 4:00

4:00 - 5:30

5:30 - 7:00

7:00 - 8:00

Email Address: *

Day Preference for Second Instrument (Choice 1)

Tuesday

Wednesday

Thursday

Lesson Format *

Lesson Format for Second Instrument

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. *

Primary Contact Phone Number *

Birthdate *

First Instrument: *

Time Preference for Second Instrument (Choice 2)

2:30 - 4:00

4:00 - 5:30

5:30 - 7:00

7:00 - 8:00

Session Availability for Second Instrument: Select the weeks you are available — choose at least 4, maximum 8:

Same as First Instrument

July 7, 8, 9

July 14, 15, 16

July 21, 22, 23

July 28, 29, 30

August 4, 5, 6

August 11, 12, 13

August 18, 19, 20

August 25, 26, 27

Primary Contact Name: *

Preferred Form of Contact (for scheduling/reminders): *

Email

Text (via Music 101 Google Voice)

Phone Call

No Preference

NEW Student summer registration