Replay Music Studios Private Lessons & Song Sessions Registration Form
2018-2019 Academic Year
Are you signing up for Private Lessons or Song Sessions? *
Name of Student *
Your answer
Date of Birth *
Age *
Your answer
Your answer
Address *
Your answer
Name of Parent(s)/Guardian(s) *
Your answer
Parent/Guardian E-mail 1 *
Your answer
Parent/Guardian E-mail 2
Your answer
School/Grade *
Your answer
Home Phone
Your answer
Business Phone
Your answer
Parent's Cell Phone *
Your answer
Parent's Cell Phone 2
Your answer
Child's Cell Phone
Your answer
Child's email
Your answer
Emergency Contact/Number *
Your answer
Relationship *
Your answer
Does your child have permission to leave the studio on their own, without adult supervision? *
Does your child have any allergies *
If yes, please explain:
Your answer
Are there any other medical issues or other information we should know about your child? If yes, please explain:
Your answer
1. Instrument(s) played: *
Your answer
2. How many years have you played/had private lessons? If so, topics covered? *
Your answer
3. Favorite bands and songs:
Your answer
For Song Sessions Students (or others, if applicable): Have you written full songs or chords, melodies, lyrics before (please specify)?
Your answer
Private Lessons & Song Sessions:
Lessons are offered in 3 trimesters during the academic year: September through December, January through March and April through June. There are 12 lessons in each 13 week trimester. Please read cancelation and make-up policy below.
Private Lessons Program (only):
Choose 30 min. 45 min. or 60 min. lessons once a week for 12 weeks. This program is for all levels.
Cost (Please choose one) - Once a student has committed to lessons, we prefer lessons purchased in packs of 6 or 8 at a time.
Song Sessions Program (only):
Choose 45 min. or 60 min. Lessons are offered once a week or every other week. This program is for songwriters of all levels of experience. Students are offered the opportunity to perform a song at a Replay event.
Cost (Please choose one)
Payment and Make-Up Policies: Private Lessons & Song Sessions
Payment is due in full before each trimester begins. Each trimester includes one make-up week built into the 13 week trimester. Cancelations and requests for re-scheduling must be made at least 48 hours in advance and we will do our best to accommodate up to 3 make-ups. Unused lessons will not be honored past the trimester for which they were purchased.
General Rules of the Studio
• Shirts, shoes and pants must be worn at all times.
• NO DRUGS OR ALCOHOL: REPLAY STUDIOS EXPRESSLY PROHIBITS the possession, sale, or use of any illegal substances on the premises. Possession or consumption of alcoholic beverages on the premises is prohibited. violation of this condition will get you thrown out and it is not up for discussion or debate.
• NO FOOD is allowed in the rooms. Non-alcoholic beverages are allowed in the rooms provided the beverage is in a sealed container (plastic bottles w/ screw-on lids, travel mugs, etc., No Glass containers) which must remain sealed when not in use
• Our spaces are for rehearsal, recording, and creativity ONLY. Please do not engage in any activity that may damage or destroy the equipment.
• Computer use in the studios is reserved for music and music related resources and to be used ONLY with a teacher. Students are not allowed to search the Internet (Youtube) without express permission/supervision of a teacher.
• Use of the following equipment is included in the class unless otherwise specified above:
(1) 5-piece drum kit, cymbals and accessories
(3) Three guitar amplifiers
(1) One bass guitar amplifier
(1) One P.A. > 2 speakers, 2 floor monitors, one mixing board, 4 power amplifiers.
(1) Keyboard
(1) Computer, monitor, mouse and keyboard for recording
Any necessary microphones, cables and stands.

• REPLAY STUDIOS is not responsible for the loss or damage of misplaced or unsupervised personal goods. Please take care of your belongings, and be respectful of everyone else’s belongings.

• At REPLAY STUDIOS we believe in working cooperatively in order to achieve the best results. All Members are expected to respect each other and respect the Band Coaches/staff.

I have read and understand the terms and conditions for registering for the Private Lessons & Song Sessions Programs and agree to the Pricing, Cancelation and Make-up Policies, and General Rules of the Studio. *
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