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www.RexburgMusic.com 2013
PIANO
LESSONS
MUSIC
CAMP
www.RexburgMusic.com 2013
Complete
and
return
this
form
with
payment
to
David
or
Denae
Love,
419
West
Main
#124,
Rexburg,
ID.
Call
208-270-0446
or
email
lovefamilypiano@gmail.com
with
any
questions
or
concerns.
Lesson
Selection
Summer
semester
consists
of
six
lessons,
day
one
of
camp
(k-6)
or
senior
group
master
class
(grades
7
and
up),
The
Amazing
Music
Race,
and
the
Disney
themed
recital.
All
fees,
with
the
exception
of
books
are
included
in
tuition.
Continuing
Student
New
Student
30
minute
lesson
+
15min
*MTT
$100
$110
45
minute
lesson
+
30min
MTT
$141.25
$151.25
60
minute
lesson
+
30min
MTT
$182.50
$192.50
*Learn
more
about
MTT
or
Music
Tech
Time
at
RexburgMusic.com
Camp
Fee
$55
$30
Sub Total _______________ Grand Total _____________ General Information Student Name________________________________________________ Age_______ DOB_____________ School_______________________________________________________ Grade ______________________ Parent(s) Name(s) _________________________________________________________________________ Address__________________________________________________________________________________ Home Phone _____________________________Cell Phone___________________________ Text: Yes or No Email____________________________________________________ How often checked?______________ Emergency Contact and phone number (other than parent)________________________________________ ________________________________________________________________________________________ Health or allergy concerns we should be aware of________________________________________________ ________________________________________________________________________________________ Main Instrument____________________ Years of study__________ Level ___________________________ Other instruments/music background_________________________________________________________ If taking lessons, list two or three of your favorite Disney movies____________________________________
Photo and Video Release Does the instructor have permission to feature photos and/or videos of this student (never using the full last name) on the studio website, email newsletters, and/or promotional items? Yes Please ask on a case-by-case basis. No By signing this form I agree to pay the amount listed above in full or in two monthly payments (circle one), The first st st payment is due June 1 and second payment is due July 1 . I also agree to the Love Family Piano Studios Policy and Procedures. (see RexburgMusic.com) Parent Signature ______________________________________________________ Date _____________________