Student Name *

First Name

Last Name

Date of Birth (if under 18)

MM

DD

YYYY

Parent/Guardian Name or Emergency Contact

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I understand that tuition is due on the first lesson of each month, payable directly to the teacher, and is not prorated for missed lessons. 48-hour notice of a missed lesson, given directly to the teacher, is requested in order to receive a makeup lesson. (In the event of illness we can be flexible with this timeline. Lessons can be taken online at any point.) When a month has 5 lesson days in it the extra one will be used to balance out a holiday or other scheduled absence; your teacher will keep you apprised of this schedule. If you'd like to stop lessons please give your teacher and/or the office at least four weeks' notice; makeups must be completed while still enrolled. Thank you. *

Yes

No