2009 Registration Form & Authorization Agreement
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Student's Name Parent Name
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Address City Zip Code
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| Home Phone # Other # |
| Email: |
How did you hear about us? ________________________________________________________
Instructor
| Instrument
| Lesson Day & Time
| Lesson Duration
| Frequency
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Guitar or Drums
(circle one) |
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40 min
60min
(circle one) |
Weekly / Bi-Weekly Weekly / Bi-Weekly
(circle one) |
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Guitar or Drums
(circle one) |
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40 min
60 min
(circle one) |
Weekly / Bi-Weekly Weekly / Bi-Weekly
(circle one) |
Payment
All students commit to music lessons for twelve weeks. Each twelve-week period divides into two, six-week terms.
Gallagher School charges tuition to students for six weeks of lessons -- twice per twelve-week lesson period.
Tuition For Twelve Weeks
40-Minute Lesson:
$420.00 = Twelve lessons (weekly), pay $210.00 per term
$210.00 = Six lessons (bi-weekly), pay $105.00 per term
Note: 15% off Tuition price when you pay in full for twelve weeks.60-Minute Lesson:$600.00 = Twelve lessons (weekly), pay $300.00 per term
$300.00 = Six lessons (bi-weekly), pay $150.00 per term
Note: 15% off Tuition price when you pay in full for twelve weeks.
We Accept (Please Check Method of Payment):
o Cash
o Check (made out to James Gallagher for Drums or David Gallagher for Guitar) - Check #_________
o Credit Card
Authorization Agreement for Payment With Credit Card
I authorize the Gallagher School of Guitar and Drums to apply a half of lesson tuition ($_________) to my credit card.
Authorized Card Holder's Signature: _____________________________________________ Date:_______________
______________________________________ __________________________________
Name as it appears on the Card Credit Card Number
______________________________________ __________________________________
Billing Address CID Number
______________________________________ __________________________________
City, State, Zip Code CC Expiration Date
I have read and agree to the Gallagher School of Guitar and Drums policies.
I understand that this authorization will remain in effect until I provide a 30-day written notice for its termination or until the date of the last payment of the specified lesson period. I also understand that there are no refunds or make-up lessons for missed lessons.
__________________________________________________ _________________________
Student, Parent, or Guardian's Signature Date of Registration
Payment Schedule
Registration Fee: $20.00 - ________
Lesson Tuition: $__________
Date of First Payment: ___________________ Date of Last Payment: _______________
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Missed Lessons Policy
1) There are no make-ups for missed lessons
2) No refunds are given for missed lessons.
Refund/Withdrawal Policy
1) 30-day written notice is required to withdraw from lessons.
2) You must sign the lesson withdrawal form provided by the school.
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www.gallagherschool.net
Gallagher School of Guitar & Drums
2037 W. Montrose Ave. Studio 1R
Chicago, IL, 60618