mfMusic Studio Registration (child)

We are registering for: *

45 Min Weekly Voice Lessons - in studio

1 Hour Weekly Voice Lessons - in studio

45 Min Weekly Piano Lessons - in studio

1 Hour Weekly Piano Lessons - in studio

1 Hour Weekly Combination Piano and Voice Lessons - in studio

45 Min Weekly Piano Lessons - in home

1 Hour Weekly Piano Lessons - in home

Student Name *

Your answer

Student date of birth *

YYYY

Student Gender *

Male

Female

School Type *

Traditional

Year-Round Track 1

Year-Round Track 2

Year-Round Track 3

Year-Round Track 4

Modified Traditional

Home School

Name of School

Your answer

Grade in School (2019-20 Academic Year)

Preschool

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Freshman

Sophomore

Junior

Senior

Has this student studied music previously? If so, please describe. *

Your answer

Is this student currently studying another instrument?

Your answer

What other after-school activities is this student currently involved in, i.e. dance, soccer, and how often each week does the student participate?

Your answer

Does this student have any dietary restrictions or allergies? If so, please describe. *

Your answer

Does this student have any physical, mental, or developmental issues pertinent to taking lessons? If so, please describe. *

Your answer

What is the student's goal for taking lessons? *

Your answer

Are there any types of music you will not allow your child to study? *

Your answer

Briefly describe the extent of both parent's musical background. *

Your answer

What kind of piano will the student be using for in-home lessons or home practice? *

Acoustic, baby grand

Acoustic, upright

Digital piano with weighted keys

Electric keyboard

We do not own a piano or keyboard

Mother's Name

Your answer

Mother's Occupation

Your answer

Father's Name

Your answer

Father's Occupation

Your answer

Mother's mobile/work phone number

Your answer

Father's mobile/work phone number

Your answer

Home phone number

Your answer

Student mobile number (age 16+ only)

Your answer

Primary email address (For all studio correspondences including invoices) *

Your answer

Secondary email address (optional for families who would like all information to be sent to two separate addresses)

Your answer

Student email (optional for students age 10 and older so teacher can send assignment links, recordings, etc directly to student as needed; parent will always be CC'd.)

Your answer

Which form of communication do you prefer? *

Text Mother's cell phone

Text Father's cell phone

Email Primary Email Address

Call Home Number

Call Mother's cell phone

Call Father's cell phone

Home Address *

Your answer

The “Lessons Swap List” allows parents of in-studio lessons to swap lesson times with other parents/students if conflicts arise. Can I list your name, email address and phone number on the "Lessons Swap List"? *

N/A (we are registering for in-home lessons)

Yes

We plan to pay for tuition in the following way: *

Total tuition and fees for year paid in full (includes discount); due July 7th

Total tuition and fees for year paid in TWO payments; due July 7th and Dec 7th

Total tuition and fees for year paid in TEN equal payments; due the 7th of each month beginning July 7th or with the first 2 payments due at registration (if it is now past July 15) and the remaining payments due one per month

By typing my name and date below, I am electronically signing this document to indicate that I have read the full mfMusicStudio Policy at www.mfmusicstudio.com/about-the-studio and agree to abide by the terms listed in the policy. *

Your answer

(This is optional) By typing my name and date below, I am electronically signing this document to grant Margaret Fontiveros the right to take photographs or videos of my family in connection with any mfMusic Studio event. I authorize Margaret Fontiveros to use and publish the same in print and/or electronically. I agree that Margaret Fontiveros may use such photographs/videos of us with or without our names and for any lawful purpose, including for example such purposes as web content or Facebook newsfeed.

Your answer

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