Student Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone 1 *

(###)

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Phone 2

(###)

###

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Can (child-age) student(s) be given sealed/wrapped snacks or candy, as treats to bring home after a lesson?

Yes

No

Maybe, see notes or comments below

Emergency Contact 1 Phone

(###)

###

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Emergency Contact 2 Phone

(###)

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Add-On Packages Requested

Exams & Honors Add-on Package ($549 for 6-month session)

In-home Lessons Add-on Package ($150/mo)

I understand and agree to the ANNUAL REGISTRATION and MATERIALS FEE ($100 per student, per year). *

Yes

I understand and agree to the MEMBERSHIP and TUITION policies and procedures. *

Yes

I understand and agree to the 12 SESSIONS (11 LESSONS PLUS 1 RECITAL) PER QUARTER policies and procedures. *

Yes

I understand and agree to the CANCELLATIONS and MAKE-UPS policies and procedures. *

Yes

I understand and agree to the SUMMER MONTHS policies and procedures. *

Yes

I understand and agree to the CARE OF STUDENTS, OPEN DOOR POLICY, INJURIES, PICKING UP STUDENTS policies and procedures. *

Yes

I understand and agree to the DISCONTINUING LESSONS and WITHDRAWAL policies and procedures (notice to be given by the 15th of the final month). *

Yes

I give permission for the image, audio and or video recording of student(s) to be used by the Dennis Frayne Music Studios, Laguna Niguel School of Music.

At the studio we host an annual picture day that is very popular with our parents. A photographer visits the school and takes pictures of the students, and parents get to order copies. We also videotape and photograph recitals occasionally. In our monthly newsletter we feature students of the month, and videotape student performances for YouTube and our website. If you would like for you or your child(ren) to participate in student of the month, picture day, recitals or our newsletter, please agree to this image and video/audio recording waiver.

Yes

No

I understand and agree to the payment authorization agreement, auto-charge, studio policies and procedures, and waivers, and agree to abide by them. *

Yes

I understand and agree that our lessons will be on the same day(s) and time(s) every week, and I will become familiar with the studio calendar for recital weeks and holiday weeks which may be off-weeks. *

Yes