String Studio
REGISTRATION FORM
September 2008
Student’s
Name_____ __________________________________________________
Address_______________ _______________________________________________
Postal
Code___________________Phone Number(s)__ _______________ _______
Email Address
(to be
used for weekly studio updates & information)__________ ____________
Mother’s
Name_______________________________
Father’s Name
_______________________________
Day
School____________________________Grade (Sept. 08)_______
Age________Birthdate
(d/m/y)_____________
Is there any
information regarding special circumstances, learning disabilities, or medical
conditions
that we should know about in order to help us teach your child to the best of
our ability?
_______________________________________________________________________________________________________________________________________________________________________________________________________________
Private Instruction Lesson Length (30/45/60
minutes)_________
Preferred Lesson
Day_______________Time________________
Alternate
Lesson Day 1.
_____________Time________________
2. _____________Time________________
Child____
Adult____
Courses registered for:
Adult Group
Guitar ____ Music Theory ____
Adventures in
Music ____ Piano ____
Child Group
Guitar ____ Viola ____
Children’s
Choir Violin ____
Classical
Guitar ____
Main Instructor:
de
Gray ____ Shmaenok ____
Ivanovic ____
Levinson ____ Uskovitskova ____
Pechenyuk Welsh ____
Pearce ____
Group Class(es): (Choose your classes from the list provided)
Technique Class:___________________
Day______________Time______________
Orchestra:
_____________________Day______________Time______________
Fiddle Class:
_____________________Day______________Time______________
Other Class:
_____________________Day______________Time______________
Tuition $_________
Theory
Supplementary $_________
Orchestra
Music Deposit Fee $_________
Choir $_________
Registration
Fee $ 30.00
____________
Total Amount
Due $_________
‘I have received
and read the Lesson policy’
Parent/Adult Student or Guardian
Signature_________________________
Office Use Only:
Date
Registered______________________Amount Paid__________________
Payment Method:_____________________
Initials: ______________________