Private Lessons Student Enrollment Form
Light in the Sky Music with Melissa - Performance Arts Education Program
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Thriving Artists Start Here!
Mrs. Melissa is passionate about performance arts education and cultivating a healthy learning environment. This is achievable when students and families also embrace the following Core Values:

Communication: Open dialogue is key.
Respect: Build a positive, collaborative space.
Preparation & Practice: Be ready to shine!
Grace & Humility: Be kind toward each other and yourself!

If students are struggling to incorporate these Core Values into their sessions or practice time, Mrs. Melissa is there to help and partner with you to create a successful learning experience!
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Refer-A-Friend:  Whom shall I thank for referring you?

*Next semester, you can see a 5% Refer-A-Friend discount!  Restrictions apply, see website for details.
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Primary Parent/Guardian Name: *
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Primary Parent/Guardian Phone Number: *
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Emergency Contact (outside of family home) Name, Relationship, and phone number
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Primary Parent/Guardian Email Address: *
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Please list up to two other people who could be regularly responsible for drop offs/pickups (Ex.: friend, neighbor, auntie, etc.) and their phone number:
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Where will private lessons take place?
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Secondary Parent/Guardian name and phone number *
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Family Mailing Address *
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Payment: *
If your family is with a CHARTER HOMESCHOOL, please list your school name, your “teacher”, and their email.
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Student #1:  Name; Age; Date of Birth;  Any allergies, health concerns, medical, or other special conditions that we should be aware of. If there are no needs, note N/A. Example:  Joe; 14, 8-22-2010; Asthma *
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Student #2:  Name; Age; Date of Birth; Any allergies, health concerns, medical, or other special conditions that we should be aware of. If there are no needs, note N/A. Example:  Joe; 14, 8-22-2010; Asthma
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Student #3:  Name; Age; Date of Birth; Any allergies, health concerns, medical, or other special conditions that we should be aware of. If there are no needs, note N/A. Example:  Joe; 14, 8-22-2010; Asthma
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Student #1 - Please choose your indicate your instrument for private lessons.  Please consult with Mrs. Melissa before making a purchase.
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Student #2 - Please choose your indicate your instrument for private lessons.  Please consult with Mrs. Melissa before making a purchase.
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Student #3 - Please choose your indicate your instrument for private lessons.  Please consult with Mrs. Melissa before making a purchase.
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Performances Expectations: Students are expected to participate in at least one recital or event per year (preferably 2) in clean and neat, semi-formal attire (Sunday best) with groomed hair and healthy hygiene. Dates and times will be announced later with as much notice as possible.  (Attire exceptions will be made when appropriate for specific classes like Shiny Time Music and Prepare to Stand-UP!)
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Behavioral Support in Private Lessons or Classes:  See my website for a detailed explanation of my Commitment to Success and learn how we will collaboratively attend to Disruptive or Disrespectful behaviors.
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Enrollment Commitments:

As a participating family, we commit to and understand the following:

Punctuality & Regular Attendance are crucial elements to the success.

Practice may require regular support from parents or private lessons.

Instrumentation matters - please do not change instruments without first consulting with Mrs. Melissa.

Snacks may be consumed during designated times.  Wash hands and rinse mouths before playing instruments. Dispose of trash properly. Leave NO Trace.

Tuition is due in full upon receipt of your invoice in order to secure your student(s) enrollment.  

Charter School $30 Retainer Fee is refundable only upon receipt of your charter school Purchase Order (PO).

Individualized Payment Plans are allowed for private-pay families enrolled LAST semester and are in good standing.

Refunds are not available. However, an exception is made for group class withdrawal by the deadline mentioned below. 

Group Class Withdrawal notice for a full refund is due in writing by Friday, September 13th, 2024.

Private Lessons Withdrawal notice is due in writing by the 21st of the month for withdrawal to take affect by the first of the following month.

Make-Up Sessions are only available for Private Lessons with 24 hours' notice.

Illness - Stay Home When Sick within the past 24 hours. ("Sick" includes a Temperature of 100.5 degrees Fahrenheit or higher.)   For private lessons, please cancel as soon as possible.

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Photo, Video, and Audio Release:
Light in the Sky Music with Melissa and Melissa Baikie-Rick have my consent that pictures, videos, and audio recordings that are taken of the students may/will be used for brochures, fliers, newspapers, newsletters, the Light in the Sky Music with Melissa website, Facebook, Instagram or any other public advertisement.  
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Release of Liability:
I sign this form as my consent for the child or children listed above to participate in all aspects of Light in the Sky Music with Melissa and her performance arts program. I, personally and on behalf of the child or children listed above, hereby waive, release, and discharge any and all claims for damages for any and all injuries, illness, losses, claims, liability, and expenses which may hereafter occur as a result of the above child or children's participation in Light in the Sky Music with Melissa performance arts program classes, workshops,, lessons, or other activities. I release Light in the Sky Music with Melissa and facility provider, Woodland Bible Church, and all volunteers, regardless of business and facility affiliation, of any liability incurred as a result of this child's attendance and participation in activities. I also give permission to Light in the Sky Music with Melissa to administer first aid or authorize emergency medical attention to the above child or children as they deem necessary.  I understand every effort will be made to contact me as quickly as possible. In the event treatment is required from physician and/or hospital personnel designated by Light in the Sky Music with Melissa or volunteer, I agree to hold such person(s) free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that I will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. I also affirm that I have legal custody of the child named above, a minor, and have given my consent for him/her to attend activities and events being organized by Light in the Sky Music with Melissa. Please sign and date:
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