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Cynthia Ali Studios LLC
Studio Policy and Sign Up Form
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Name: First and Last Name
Address: House #, Street, City, State, Zip
Choose lesson type:
Child with parent's permission
Billing: Payments for one month of lessons are due, in advance, by the first lesson of the month. You will be emailed an invoice from SQUARE on the first of the month. ($25.00 per week) You can use Credit/Debit card to pay the invoice sent to you at your current email using SQUARE.
Yes, I agree to receive invoices monthly by email to pay online via Square.
No, I do not agree to receiving monthly invoice by email.
Email: (Your email will be used for contacting you and sending you invoices.)
Online Lessons Procedure: You will need: 1) A computer/laptop, iphone, ipad 2) Microphone 3) Webcam 4) Ethernet cable for computer/laptop (optional, but helps with faster speed and less freezing) 5) ZOOM –
(connection software, FREE) If you need help setting up for online lessons, please contact Cynthia Ali at
or text 651-558-7644 to schedule a FREE setup time. Once you submit your registration I will give the Meeting ID and Password to connect. Please arrive to your lesson a few minutes early. If there are technical problems during a lesson that cannot be resolved, the lesson will be rescheduled for a later date. You will not be charged for the lesson, if technical problem cannot be resolved.
Yes, I agree to the procedure for online lessons.
No, I do not agree to the procedure for online lessons.
Books & Materials: The cost of book and materials costs is determined by your level. Students can purchase music and materials at local music stores or online. Approximately $20 - $25 per level.
Yes, I agree to purchase books and materials that are needed.
No, I do not agree to purchse books and materials that are needed.
Cancellations of a weekly lesson: Contact Cynthia Ali in advance if you need to cancel a lesson due to sickness or unexpected emergencies. Please give Cynthia notice at least 24 hours in advance, if possible. Then your spot can be used for makeup lessons for another student. Call or text Cynthia's cell phone at: 651-558-7644. Cynthia Ali will contact you if she needs to cancel lessons. The payment for the lesson missed will be credited only if you are sick or have an emergency.
Yes, I agree to the cancellation policy.
No, I do not agree to the cancellation policy.
Unpaid lessons: On the third week your time slot will be forfeited and you will be billed for unpaid lessons. Payment is due upon receipt of invoice.•
Yes, I agree to the forfeiture of my lesson spot if I do not pay by the third week of the month.
No, I do agree to the forfeiture of my lesson spot if I do not pay by the third week of the month.
No Call/No Show: If you do not call, text or email to let Cynthia Ali know that you will not be at your lesson, you will be charged $25 for the lesson.
Yes, I agree that I will be charged $25 if I NO CALL/NO SHOW.
No, I do not agree that I will be charged $25 if I NO CALL/NO SHOW.
Attendance: Cynthia Ali can only save a specific time slot if you are committed to weekly lessons. If attendance become sporadic, lessons will be changed to “by appointment only”. Cynthia will talk with you if this happens. You can book your lessons at
for online using ZOOM.
Yes, I agree that I will change to "appointment only" lessons if my attendance is sporadic.
No, I do not agree that I will change to "appointment only" lessons if my attendance is sporadic.
For Parents of Minor Children: Parent or guardian must be present during the child's lesson. Parent must log in student and be present to ensure the student's safety.
Yes, I agree to be present during the lessons of my minor child.
No, I do not agree to be present during the lessons of my minor child.
I am an adult, so this does not pertain to me.
Parental Responsibilities: Ensure that the student arrives at the lesson on time. Make regular/timely payments. Give at least two week's notice if your student wishes to discontinue lessons. Provide necessary support materials: A playable instrument in good repair, Music—available through local music stores and online, metronome, and quiet place for practice. Create an environment which encourages practicing. Keep in regular communication with both teacher and student about progress and goals. Keep your email address and contact information up-to-date. Cancel lessons within the 24 hr. cancellation period, or as soon as possible. Call or text Cynthia Ali's cell at: 651-558-7644
Yes, I have a minor child and agree to the parental responsibilities.
No, I have a minor child and do not agree to the parental responsibilities.
I am an adult, this question does not pertain to me.
Termination of Lessons: If you quit lessons, you will be sent a bill for any unpaid lessons. Payment will be due upon receipt. Students may terminate lessons at anytime for any reason. If you have prepaid for unused lessons and quit you will be NOT be reimbursed. You will have a credit to use for lessons only. Teacher may terminate lessons at anytime for any reason.
Yes, I agree to the termination of lessons policy.
No, I do not agree to the termination of lessons policy.
Student Responsibilities: Prepare all lessons with sufficient practice. Bring your books to all lessons. Come to lessons on time. Maintain and care for your instrument—take care of needed repairs. Plan to participate in virtual recitals. Enjoy being a musician!
Yes, I agree to the student responsibilities.
No, I do not agree to the student responsibilities.
By submitting this form you agree to the Cynthia Ali Studios Policy.
Yes, I agree to the studio policy.
No, I do not agree to the studio policy.
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