|First Name ||Middle Initial |
|Gender ||Male Female |
|Birth Date ||/ / |
|Street Address ||Apt. No. |
|City ||Zip Code |
|E-mail Address |
|Cell Phone ||( ) - |
|Home Phone ||( ) - |
|LIST THE COURSES YOU WANT TO TAKE|
|Course #||Course Title|| Fee|
|1 ||$ |
|2 ||$ |
|Total Enclosed: ||$ |
PLEASE SUBMIT PAYMENT WITH YOUR REGISTRATION TO GUARANTEE ENROLLMENT.
Credit and debit cards are accepted. Please submit the completed registration form FIRST and click "CONTINUE" to direct you to the online payment page. If using US Mail or dropping off registration at The Piano Studio when it is closed, please pay by check. DO NOT MAIL CASH or DROP OFF CASH when the studio is closed.
Your signature is required regardless of payment method and signifies you have read the Liability Waiver.
Cash Check (Payable to Sam Yip)
Credit or Debit Card
Liability Waiver: By signing below, the student agrees that neither THE PIANO STUDIO nor its instructors shall be liable for any and all injuries, loss, and other damages that may be suffered by reason of voluntary participation in class activities. The waiver is effective as long as the student is taking classes or lessons at the studio. No refunds or credits after the second class unless the class is canceled by administration. A minimum of 48-hour notice is required to reschedule private lessons. Your signature is required below. You may type in your signature. Thank You!
I consent to my child taking lessons at The Piano Studio and
I have read the Liability Waiver above.
(For students under 18)