Student Registration Form 2019-2020 Student InformationStudent Name* First Last Desired Instrument(s)* Piano Voice Audition Prep Music Theory Songwriting Please select all instruments that the student is interested in studying.Student Date of Birth* Date Format: MM slash DD slash YYYY Grade*Pre-KK1st2nd3rd4th5th6th7th8th9th10th11th12thCollege StudentAdultSchool*If you are an adult student, please enter "Adult"Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell Phone*Does this student have any allergies or medical conditions that our instructors should be aware of?*YesNoPlease list any allergies or medical conditions:*Student AvailabilityPlease choose the days and times that your child is available for lessons.Days Available*Please select all that apply. Please note that not all teachers are available every day of the week. Mondays ~before school 7:45am Mondays ~after school Tuesdays ~before school 7:45am Tuesdays ~after school Wednesdays ~before school 7:45am Wednesdays ~ after school Thursdays ~before school 7:45am Thursdays ~after school Fridays ~before school 7:45am Fridays ~after school Saturday Sunday Times available*Of the days selected above, please provide a time range that you or your child is available for lessons. For example : 2:30-5pm.Parent 1 InformationParent 1 Name* First Last Parent 1 Cell Phone*Parent 1 Email* Parent 2 InformationParent 2 Name* First Last Parent 2 Cell Phone*Parent 2 Email* Policies and PermissionsTuition and Enrollment Policy Agreement* I agree to Michelle Lavin Music's Tuition and Enrollment PolicyLesson tuition is due at the beginning of each semester for the entire semester. Michelle Lavin Music accepts check, cash, Venmo, and PayPal. Tuition is due by the first lesson each semester. A late fee of $15.00 will be charged for every 30 days past due. Student’s have the following options for tuition payments: MONTHLY TUITION PAYMENTS (PayPal or Monthly Auto Bank Draft):All monthly tuition payments will be processed automatically on the 15th of each month. SEMESTER TUITION PAYMENTS (Check, Cash, Venmo): Tuition submitted for the semester is processed through your choice of check, cash, or Venmo and is non-refundable. -A studio fee of $50 will be charged per student to cover the cost of sheet music, lesson planning, curriculum development, recital programs and rental space, and studio expenses such as copying and other supplies needed for the semester lessons. -A one time non-refundable deposit of $100 will be required to reserve a lesson time slot for the Fall. This deposit will be applied towards your Semester 1 tuition. NON-SUFFICIENT FUNDS (NSF) FEE:In the case of an ACH Transaction or check being rejected for Non Sufficient Funds (NSF) I understand that Michelle Lavin Music may, at its discretion, attempt to process the charge again within 5 days, and agree to an additional $25 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. Cancellation Policy* I agree to Michelle Lavin Music's Cancellation PoliciesConsistency of lessons is essential for productive musical training. Please read the following carefully: ~Makeups will no longer be offered for student canceled lessons, regardless of the time frame given. Because specific times are reserved for each individual, a student that cancels or is a no show will simply miss that lesson. The teacher can use their discretion in regards to illness /family emergency. ~In the event the teacher is more than 15 minutes late for their scheduled lesson, the student will receive a credit or makeup lesson. ~If the student is late by more than 15 minutes, the teacher may leave and the student will be charged for the lesson. School activities such as class trips, sports practices and games etc. do not qualify for a make-up lesson. Students may however attend a group class (when available) to make-up a cancelled lesson. ~Last minute cancellations and no-shows will necessitate charging the full lesson fee as well as the additional fee of $10. We cannot make exceptions to this policy. Please do not come to your lesson if you are sick! We reserve the right to send a student home if they are ill. Alternatives include a live virtual lesson with your teacher during your regularly scheduled time, an assigned instructional video to be watched at anytime throughout the week, or a makeup may be offered at the discretion of the teacher. There will be NO CREDITS given for missed lessons by the student- NO EXCEPTIONS. ~An additional fee of $10 will be charged in addition to the lesson fee if the student is a no show. ~An additional fee of $10 will be added in addition to the lesson if the student cancels last minute. Group Class Policy: There will be no refunds given for group classes after the class has met one time. Photo Release* I agree to Michelle Lavin Music's Photo Release policyMichelle Lavin Music is hereby granted permission to take photographs of the students to use in brochures, web sites, posters, advertisements, and social media. I have read and understand the policies put forth by Michelle Lavin Music and its instructors and agree to all terms and conditions. I would like to receive lesson reminders as follows*Please check all that apply Text message reminders Email reminders Pleased not send lesson reminders Registration DepositA non-refundable deposit of $100.00 is required to register for lessons. YOUR LESSON SPOT IS NOT SECURE UNLESS YOU HAVE REGISTERED AND SUBMITTED YOUR DEPOSIT. The deposit will be deducted from the student's first semester tuition. Private Lesson Deposit Price: $100.00 Deposit Invoice* I understand that I am responsible for the deposit amount above.Once your registration form is submitted, you will receive an invoice for the deposit amount plus materials fee. Please understand that the registration is not complete until the deposit is paid.