Replay Music Studios Registration Form
2016-2017 Academic Year
Are you signing up for Band Coaching or Discovering Rock? *
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
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
The information from the following questions about your child will be used to help us place him/her into the best possible band situation taking into account age, experience and interests:
1. Instrument(s) played:
Your answer
2. How many years have you played/had private lessons?
Your answer
3. Favorite bands and songs:
Your answer
4. Have you played in a band before?
Your answer
5. Do you sing/want to sing?
Your answer
What are your top two days to rehearse (check 2)? *
Permission To Use Child's Likeness:
I, on behalf of my child, grant Replay Music Studios and its agents and employees the right and permission to record and photograph my child, and consent to and authorize the use and reproduction by Replay Music Studios of any and all photographs, recordings, videotapes, and/or other reproductions of likenesses of my child’s person and characteristics (“reproductions”) for any purpose whatsoever that is related to the marketing of Replay Music Studios, without compensation to the student and without notification to me. All reproductions shall be the property of Replay Music Studios, solely and completely. Further, I assign and release all rights to said reproductions, and authorize Replay Music Studios, or others authorized by them, to exhibit, broadcast, and/or distribute or otherwise further reproduce said reproductions in whole or in part over or in any medium whatsoever, including, without implied limitation, newsletters, radio, newspapers, film, cable, television, and digital media, without compensation, in perpetuity.
I give permission to Replay Music Studios to use my child's likeness: *
The following is for Discovering Rock, only (Band Coaching, see below)
Fall Semester 2016
12 Week Semester

Cost: $540

Starts September 12 and ends December 9.

Showcase tentatively scheduled for Sunday, December 11, 2-5pm.

Winter/Spring Semester 2017
18 Week Semester

Cost: $775

Starts January 9 and ends June 9.

Showcase date June, 2017 (TBA)

The following is for Band Coaching, only:
Description & Pricing: Band Coaching
Band Coaching is a month to month membership, year-long program that includes:

• Weekly 1.5 hour band coaching sessions
• One hour of independent rehearsal time per week (based on availability)
• Free workshops
• Opportunities to play in sponsored showcases and other events
• 15% discount on private lessons.

Cost: $289/month. See payment schedule below.

Add Private Lessons (Band Coaching)
Weekly lessons based on the same calendar as Band Coaching sessions.
Additional Private Lessons Monthly Cost (check one):
Schedule and Make-Up Policies: Band Coaching
Fall Semester: Monday, September 12 – Friday, December 9 (13 weeks)
12 band sessions plus 12 private lessons (if applicable). There is one holiday built in to the 13-week semester. Check calendar on our website for holiday schedule. Additional missed rehearsals may be rescheduled per the policy below.

Winter/Spring Semester: Monday, January 9 – Friday, June 9 (22 weeks)
20 band sessions plus 20 private lessons (if applicable). Our schedule allows for 2 missed weeks in the 22-week semester to accommodate school breaks. Additional missed rehearsal sessions will be scheduled and made up based on the needs of the bands.

Make-Up Policy: If more than half of the members of a band are unable to make a rehearsal, and we are given at least 48 hours notice, we will do our best to reschedule the rehearsal. While we do our best to accommodate every group and individual schedule, we cannot guarantee make-ups beyond those provided in the calendar.

Private Lessons: If selected, monthly payment is due as part of tuition for the band coaching program. Cancelations must be received at least 48 hours prior to lesson time in order to be rescheduled or lesson fee will be forfeited.

Payment Terms and Cancelation Policy: Monthly payments of $289 + amount for private lessons (if purchased) are due: September 12, October 15, November 15, January 1, February 1, March 1, April 1 and May 1. Payments are based on four rehearsals per month but please note exact number of rehearsal sessions per month may vary based on calendar. We must receive at least 30 days notice to cancel participation in the program or a one month cancellation fee will apply.

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.
• 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 Band Coaching or Discovering Rock Programs and agree to the Pricing, Cancelation and Make-up Policies, and General Rules of the Studio. *
I hereby request and authorize Replay Music Studios to charge my credit card on file with all monthly payments as defined in the aforementioned Payment Schedule (Discovering Rock: Check Option 3). *
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