Brandywine Music/Piano Studio

Piano Lessons, Music for Special Occasions

Brandywine Music Piano Program

Registration Form/Parent-Teacher Agreement

2018 – 2019 School Year

 

Student’s Name (1) ____________________________Birthdate___________Grade in school_____

Student’s Name (2) ____________________________Birthdate___________Grade in school_____

Parents’ Names________________________________________________________

Address______________________________________________________________

Cell Phone (parent who will usually bring student)______________________

Cell Phone (other parent)______________________Home Phone_________________

Email address(es)_______________________________________________________

Preferred method of communication:  Email___Text message___Phone call___

 

Student’s music experience(1)___________________Student(2)__________________

Parent’s music experience_________________________________________________

Do you have a: piano (acoustic)___Tuned/in good repair?_____

OR: Digital piano___full-size___weighted keys___ Keyboard (non-weighted)___# of keys___

Referred by/how you found me____________________________________________

 

Style(s) of music instruction desired (check all that apply):  Traditional___Suzuki___

Rigorous classical___Recreational pop___Variety___Other (specify)__________________

____________________________________________________________________

Please describe any learning style/difference/disability that I should be aware of (ex.:

visual learner, auditory learner, very active, very shy, physical impairment, dyslexia,

AD/HD, autism) or serious allergy  (1)_____________________________________  

Student(2)____________________________________________________________

Management suggestions________________________________________________

 

                                                                                                                                        

___Please check here if you do NOT consent to your student’s use of electronic apps/games 

___Please check here if you do NOT consent to photos or videos of your child to be posted

on the Internet or used in promotional materials. (Students' full names are not used.)

 

HOURS: Mon. - Thurs. 1:00 – 8:00 pm; Fri. 3:00 – 6:00 pm

Please specify ALL of your day and time availabilities: __________________________________

_____________________________________________________________________________

 

TUITION FEE DEPOSIT:  $50/one student, $75/2 students, $100/3 or more students, due at first registration (unless full tuition paid) and each July 15. (See Membership/Tuition page) This will apply towards your first quarter tuition.

 

I agree to the terms and policies of this studio and agree to indemnify, release and hold harmless

Diana L. Umile or her associates from any claims or causes of action arising or related in any respect

to the activity or the child’s participation in such activity.

 

Parent’s Signature_____________________________________________Date_____________