Northwest School of Music Registration Form
Please complete this form to confirm your registration for lessons at NWSM
Student Name (If there are multiple students, please write their information in the same order for the duration of this form)
Student Birthdate (continued for multiple students in a family)
What Musical Experience Does the Student Have?
Parent/Guardian Name (Write Adult if you are are 18 or older)
Email Address for Adult Responsible for Lesson Invoices
Best Phone Number to Contact
Does this number text?
Address (Including City, State, and Zip Code)
In What Instruments Are You Seeking Instruction?
Studio Policies to follow. Please see the website
if you need to review them, or contact the office!
Students are given an assignment binder/folder after registering, which is used to keep track of assigned pieces and practice suggestions/goals for each week. All second year and higher students should have and regularly use a metronome. The teacher will obtain all needed books and materials for the student. The $10 monthly registration fee covers the cost of all needed books and materials through the year, and full access to NWSM resources; however, if it is insufficient (due to unusual student demands) the student/parent is expected to cover the additional costs. New materials for the library may be purchased at student request. Please treat library materials with care. Damaged materials must be replaced at students' expense.
I Understand the Materials Policy
Tuition and Payments
Students have the option of paying tuition in one of the three following methods.
In equal monthly installments. Payments are due by the 10th of each month. Invoices are sent through email or through mail by request only. Please see our rate schedule for the amount due each month.
In two equal installments. Payments are due August 10th and February 10th. Students receive a 5% discount. These totals can be requested.
Students who would like to pay at each lesson, will pay a higher amount: $35 for 30 minute lessons, $50 for 45 minute lessons, and $65 for 60 minute lessons.
Payments may be mailed (postmarked by the 10th) or given to the teacher at a lesson. Late payments and returned checks will incur a late fee of $20. Unpaid late fees may result in the termination of the student’s contract. NWSM reserves the right to adjust fees at the beginning of each new academic year.
Tuition may be paid via cash, check, card, automatic deposit using bank routing number (email
for information on setting this up with your bank account), or online via card or bank transfer.
I Understand NWSM's Tuition and Payments Policy, including that a Late Fee is Issued after the 10th
Due to our full schedules, makeup lessons cannot be guaranteed. However, if an absence arises due to unforeseen circumstances, such as an accident or family emergency, and the student indicates a desire for a makeup lesson, the teacher/office staff will make an effort to accommodate a makeup. Please be courteous to the teacher and fellow students by notifying the teacher at least 24 hours in advance regarding any known upcoming absences.
If a makeup lesson is not able to be scheduled, students may be able to attend a group lesson instead, or a lesson with a different Instructor than normal.
*Disclaimer* Absences with less than 24 hours' notice have their right to a makeup lesson forfeited and will only be issued on a case by case basis.
If given significant notice (prior to the start of the month) of upcoming vacations or other absences, reduced month tuition for those months can certainly be negotiated; otherwise, tuition must be paid in full each month, regardless of the number of lessons the student actually attends.
All make up lessons automatically expire within 90 days.
I Understand the Makeup Lesson Policy
The annual amount covers 47 lessons each calendar year. NWSM does not provide lessons during the two weeks surrounding Christmas, the week of Thanksgiving, spring break week, and one week during the summer months while the student's teacher is unavailable.
NWSM follows the Salem/Keizer School Districts to determine when to close doors, move lessons online, or reschedule.
I Understand the Calendar
Yes, I understand that I will be charged the same pro rated amount every month, despite the number of lessons I receive (exception is a prior lesson cancellation before the month begins)
Discontinuation of Lessons
Every student stops taking lessons at some point. Ideally, this decision is made thoughtfully with plenty of discussion between the teacher, parent, and student so that lessons can cease with a positive sense of closure. For this reason, we ask for two weeks' notice prior to discontinuing lessons. However, the teacher respects the student’s right to end lessons at any time. Note: At the discretion of the Director, students may be asked to discontinue lessons at any time if they have unpaid tuition, excessive amount of absences/unprepared lessons, or if a lack of interest is shown.
I Understand NWSM's Discontinuation Policy
Yes I understand I am obligated to give two weeks' notice to discontinue lessons.
Do you agree to the polices at NWSM
Confirm the student commits to making consistent practice part of their weekly schedule.
Yes, I understand that my dedication, passion and perseverance are important for success.
Please Confirm You Have an Instrument on which to Practice
For Online lessons, please confirm that you have a reliable device (computer, laptop, or tablet) that you can use for weekly online lessons. Please also agree to have your device charged and ready at your lesson time.
Not Taking Online Lessons
For In-Home lessons, please confirm that you have a reliable instrument and space that you can use for weekly online lessons. Please also agree to have your space clean and prepared without extra distractions.
Not Taking In-Home Lessons
Lessons at NWSM are time slots, not a duration of minutes. If you are late for your time slot, minutes will not be added to the end of your lesson. Please see the policy on absent and cancelled lessons if you have any questions.
What Days are You Available for Weekly Lessons? (Check All that Apply)
What Times are You Available generally? (Check All that Apply)
Later than 6pm
Do You Already Have An Instructor In Mind?
Feel free to visit our website at
as an introduction to our instructors!
Mallory Livingston, Executive Director (Piano)
Michelle Reed (Violin, Viola, Piano)
Ethan Keleher (Piano)
Brandon Franko (Voice)
Jake Cokeley (Piano, Guitar)
Trevor (Cello, Guitar, Bass Guitar, Piano)
Melody Morrison (Piano)
Kailey VanOcker (Trumpet, Saxaphone, Guitar, Voice, Piano, Kindermusic)
Periodically instructors observe each other during lessons. This is to further their own teaching and give opportunity to collaborate and grow into stronger musicians and teachers. Thank you for choosing Northwest School of Music!
By signing below, I certify that I have read, understand, and agree with the policies and procedures listed above, and those on the Northwest School of Music website.
*Registration form must be filled out by a legal parent/guardian, and the legal parent/guardian must agree to be held ultimately responsible for tuition payments, regardless of what other outside arrangements may be made.
I Understand, and I agree to all NWSM Policies
If you have a coupon code please enter the phrase below.
Where did you hear about us?
Word of Mouth
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