Register for Private Lessons Studio Connect Private Lesson Registration Form Child #1 Name * First & Last Name Child #1 Birth Date * Child # 1 Is Enrolling In..... * Private Voice Lessons Private Piano Lessons Private Violin LessonsPrivate Violin Lessons Private Viola Lessons Lesson Day and Time Based on prior agreement with private studio manager Child #2 Name First & Last Name Child #2 Birth Date Child #2 Is Enrolling In... Private Voice Lessons Private Piano Lessons Private Violin Lessons Private Viola LessonsPrivate Viola Lessons Lesson Day and Time Based on prior agreement with private studio manager Child #3 Name First & Last Name Child #3 Birth Date Child #3 Is Enrolling In.... Private Voice Lessons Private Piano Lessons Private Violin Lessons Private Viola LessonsPrivate Viola Lessons Lesson Day and Time Based on prior agreement with private studio manager Contact Information Parent Name * First & Last Name Parent Name First & Last Name Street Address * Street Line 2 City State Zip Code Phone Number * Alternate Phone Number Email Address * Caregiver Name If Other Than Parent Bringing to Lessons First & Last Name Does the child/ren you are registering have special needs? Please explain. Referred to Studio Connect by: Payment Preferences Class Fees Will Be Assessed At The Beginning of Each Month. Fees For Class Books or Materials May Be Additional * I understand and agree to the fees for this class. Tuition Payment Method * Cash or Check Credit / Debit Card Responsibility * I understand that if at any time I am paying by debit or credit card, it is my responsibility to keep my credit card information up to date. Any delays in current information may result in payments beyond my agreed upon session or doubled charges in order for my account to remain current. Type of Credit Card * VisaMastercardAmerican ExpressDiscover Credit Card Number (must be provided to process payments) * Expiration Month January February March April May June July August September October November December Expiration Year 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Security Code (on back of card) * Card Holder's Name * As it appears on the card Card Holder's Street Address * Street Line 2 City State Zip Code Photo Permission * You have my permission to use photographs or video of my child from lessons for occasional promotional postings (no last names used). You do not have my permission to use photographs or video of my child from lessons for occasional promotional postings (no last names used). Total Number of Children You are Registering? * 1 2 3 reCAPTCHA
