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Amati 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________________ |
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 Forest | ____ | Rittich | ____ |
| Gray | ____ | Shmaenok | ____ |
| Ivanovic | ____ | Sterling | ____ |
| 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: ______________________
