Registration Form

REGISTRATION

Name

First Name

Middle Name

Last Name

Home Address

City

Zip

Phone (H)

Cell

Work

Cleveland Ward

Child's School

Child's Age

Father's Name

Mother's Name

Or Guardian's Name

Person Responsible For Tuition Payments

What instrument(s) is (are) the student interested in learning?

Billing Address

City

Zip

Same as student’s

Has the student had lessons before?

Yes

If yes, who was the instructor, where was the instruction and what instrument?

Previous Instruction

Teacher

How Long

The Registration Fee of $30 or $40, which is not refundable, and the first month's payment on lessons must be paid at time of scheduling.

ALL LESSONS MUST BE PAID FOR WHETHER TAKEN OR MISSED. Notification of your inability to attend a lesson is a courtesy but does not exempt you from payment. If your teacher is absent, the lesson will be made up, or the student will not be charged. If the student is absent for the make-up, he or she is still responsible for payment.

CONTRACTING FOR INSTRUMENTAL OR CLASS INSTRUCTION THEREBY OBLIGATES A STUDENT FOR THE ENTIRE SEMESTER. The signing of this form implies the observance of all rules and regulations of The Broadway School of Music & the Arts.

Signature of Parent/Guardian

Date

BSMA Registrar

Date

Registration Form

REGISTRATION

Address:

Phone:

Registrar Office and Lesson Hours:

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