Eugene's Music Studio - Adult Registration Form

Musician Information

Musician's Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Lesson Location*

In-HomeIn-Studio

Home Number*

Area CodePhone Number

Cell Number*

Area CodePhone Number

E-mail*

Last Name

This and any future payment methods are subject to the terms of this registration form.

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the musician have any allergies, chronic illness, or medical conditions? If yes, please describe.

Liability Release

Private Lesson and Ensemble Policy:

Cancellations and Makeup Lessons

Two private lessons per semester will be made up. All cancellations must be made 24 hours in advance in order to be made up. If a cancellation is made without 24 hour notice, no makeup will be given. All cancellations due to illness must be made before 10:00 a.m. in order to receive a makeup. Two opportunities will be offered for each makeup. If both are refused the lesson will be considered made up. If a student cancels or is not present for their scheduled makeup lesson, the makeup may not be rescheduled and the lesson will be considered made up. No makeup lessons will be carried over into the next semester. It is your responsibility to schedule any makeup lessons.

Refunds for Private Lessons

Registration fees are non-refundable. A Eugene’s Music Studio credit will be applied to any withdrawal from individual instruction or classes until the fourth week of the semester on a prorated basis. However, no credit will be issued after the fourth week of classes, except in cases of prolonged illness. Tuition is fully refunded if the student withdraws before the first class or lesson. A 7% Refund Fee will be charged for all refunds. There are no refunds after the first lesson or class. Additional fees may be incurred for materials (books, etc.) necessary for lessons, if not purchased by the student/guardian. Eugene’s Music Studio is not responsible for lost or stolen property. My picture may be used for publicity purposes.

To ensure continuity of your musical education, your registration is ongoing. Tuition is billed semesterly and charged upon registration. Semesters are from September to January (Fall), February to June (Spring), and July to August (Summer).You will be automatically registered and charged for each consecutive semester, unless we receive written or emailed cancellation. Fall and spring registration fees of $75 will be divided into monthly installments. These fees will be prorated for mid-semester registration. The registration fee reserves your weekly lesson time for the semester. Tuition increases 4% annually on July 1st.

Any declined credit card fees will be applied to the next payment in the amount of 3.5%. Any chargeback fees will be applied to the next payment in the amount of $25.

I certify that I have read and accept the policies laid forth by Eugene’s Music Studio.

Signature*

By signing, I certify that I have read and accept the policies laid forth by Eugene’s Music Studio.

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