Suzuki Registration

Denison Suzuki Program
Term Agreement

I, the undersigned, agree that I am financially committed to private lessons for the duration of the semester. If I decide, in consultation with my child's teacher to discontinue lessons before the end of the semester, I am still obligated to pay for all private lessons that I have registered for the semester. This policy guarantees the teachers' salaries and schedules.

Please complete the form below. Thank you!

I have read the above policies and agree to adhere to these policies.

Agree

Required

Please select length of private lessons for your child. There is also a $15 program fee per student that will be added to the following rates. (PLEASE CHECK ONE) *

(30 minute lessons) @ $28 each

(45 minute lessons) @ $39 each

(60 minute lessons) @ $52 each

Required

Please select the number of lessons for your child (between 6 and 16) *

Other:

Todays Date

YYYY

Student LAST name *

Student FIRST name *

Instructor *

Parent 1 LAST Name *

Parent 1 FIRST Name *

Preferred Phone Number *

(Please include your area code and enter in XXX-XXX-1234 format)

E-Mail *

Address Information

Street Address *

City *

State *

(Two letters please)

Zip Code *

Parent 2 Information

Parent 2 LAST Name

Parent 2 FIRST Name

Preferred Phone Number

(Please include your area code and enter in XXX-XXX-1234 format)

E-Mail

Street Address

City

State

(Two letters please)

Zip Code

I will allow the Denison Suzuki Program to use photos or video recordings of myself or my child(ren) for publicity purposes. I understand that my name and the name of my child MAY BE included with the photo and/or video. *

I agree

I disagree

Required

Book Level

Other:

Instrument *

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