Yellow Springs Music Co.

CONTACT INFORMATION

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

STUDENT INFORMATION

Students First Name *

Last Name *

Birth Date * +

School (If applicable)

Grade

ADDITIONAL INFORMATION

Instrument *

Student Availability

Time

Morning

Afternoon

Early Evening

Desired Length *

30 Minute Private Lesson ($40.00)

45 Minute Private Lesson ($50.00)

60 Minute Private Lesson ($60.00)

REQUIRED POLICIES AND AGREEMENTS

Cancellations/Make-up Policy/Sick Policy
Please allow at least 12 hours notice prior to a scheduled lesson to inform us of a cancellation. We can schedule one make-up lesson per month if we are given at least 12 hours notice. You will be charged for all missed lessons if you are unable to inform us of a cancellation with at least 12 hours notice. If a student is sick, has a cold, or anything contagious we ask that you inform us in advance. There is no charge for a missed lesson if a student is sick. In case of illness, please inform Yellow Springs Music Co. via phone or email with as much notice as possible and no later then the time of a scheduled lesson.

I've read the above and agree

*

Release of Liability
As the legal parent or guardian, I release and hold harmless Yellow Springs Music Co., its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, that may be sustained by the participant and/or the undersigned, while under the control and supervision of Yellow Springs Music Co., its owners and operators.

I've read the above and agree

*

I AGREE TO ALL OF THE ABOVE

Enter your Full Name *

QUESTIONS OR CONCERNS

Comments