Eugene's Music Studio - Registration Form

Musician Information

Musician's Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Which program would you like to participate in? (Early Childhood classes are groups of up to 8 students and caregivers)*

Private Lessons (All ages)Early Childhood Baby Music (4-18 months, 45 minutes)Early Childhood Toddler Music (18 months - 3 years, 45 minutes)Early Childhood Pre-K Music (preschoolers, 3-4.5 years, 45 minutes)Early Childhood Big Kid Music (kindergarteners, 4.5-6 years, 60 minutes)LTNS Music Enrichment Fall 2019 - Spring 2020Halloween-themed Spooktacular Music Class

Lesson Location*

In-StudioIn-Home

Parent/Guardian Information

Name*

First NameLast Name

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.

Is the musician prescribed an inhaler? If yes, please explain any instructions.

Liability Release

Private Lesson and Ensemble Policy: (for Early Childhood please scroll down)

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 child’s 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 are added to your semester bill. 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.

Early Childhood Policies:

Cancellations and Makeup Classes

Two classes per month 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 class will be considered made up. If a student cancels or is not present for their scheduled makeup class, the class may not be rescheduled and will be considered made up. No makeup classes will be carried over into the next month. It is your responsibility to schedule any make up classes.

Refunds for Early Childhood

Registration and materials fees are non-refundable. A Eugene’s Music Studio credit will be applied to any withdrawal from classes until the second week of the month on a prorated basis. No credit will be issued after the first week of the month, 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. Eugene’s Music Studio is not responsible for lost or stolen property. I agree that my child’s and my picture may be used for publicity purposes.

To ensure continuity of your musical education, your registration is ongoing on a monthly basis. You will be automatically registered and charged for each consecutive month, unless we receive written or emailed cancellation.

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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