Prairie Music & Arts Summer Accents Registration 2020
Registration for private lessons, camps, workshops, and weekly classes held during the months of June-August, 2020 .
Student Name *
Your answer
Parent/Caregiver Name (s) *
Your answer
Primary Telephone Number - Please format (000) 000-0000 (Contact Name) *
Your answer
Secondary Telephone Number - Please format (000) 000-0000 (Contact Name) *
Your answer
Billing Address *
Your answer
City
Your answer
Zip Code
Your answer
Grade Fall of 2020 *
Your answer
Email address of primary parent/guardian contact: Please list the email address most frequently checked in your household. *
Your answer
For current PMA students, please type the name of your private instructor below. Please also list your student's instrument (ex. Julie Baskinger - Piano)
Your answer
I have read and will adhere to PMA's full policy statement. http://tiny.cc/m8bf7y *
NEW STUDENTS: Please select your instrument
I agree to allow Prairie Music & Arts and the instructor assigned to my student to administer a private music lesson or group program using an online email account. *
I agree to have one parent/guardian/caregiver present at home during the duration of the virtual classroom in order to protect the rights of my student(s). If a parent/guardian/caregiver is not available, I understand we may forfeit the lesson or group class. *
I fully understand Prairie Music & Arts employees are responsible for the content of the virtual classroom, the character of their instruction, and their professionalism as outlined in their employment contract. *
I understand and agree not to hold Prairie Music & Arts responsible for software or app issues, internet service drops, insufficient bandwidth, or any other technical issue that hampers a lesson or causes it to be canceled on the part of equipment or services used by either Prairie Music & Arts or myself. *
I agree and understand no makeup, refund, or credit will be given for failure to attend a virtual summer program as outlined in the full Prairie Music & Arts policy. I agree to call and email both the instructor and Prairie Music & Arts by noon the day of a lesson should I need to miss an online program for any reason. *
I understand no recording, publishing, or rebroadcasting of the virtual classroom will occur from members of both parties (student/family and instructor) *
I agree to have my student (s) share recorded videos or audio with Prairie Music & Arts. I am aware that any recordings shared will be used for the promotion of the school through school public social media platforms only through written email approval. *
By clicking "yes," I fully agree with the outlined policies for virtual programs by Prairie Music & Arts. This serves as my digital signature and binds me to the terms and conditions put forth in this document. I further understand no tuition reimbursements or makeup lessons will be given during this time unless due to extreme circumstances. *
Next
Never submit passwords through Google Forms.
This form was created inside of Music Academy of Sun Prairie, Inc. Report Abuse