Carolyn Emery Piano Studio Student Registration

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Contact me at (801) 637-3694 or CarolynEmeryPiano@yahoo.com to request a time slot.

This form does not reserve a time slot or guarantee that I have one available.

This form also does not change your time slot if you are already on my schedule.

Email *

Student Name(s) *

Method of Payment *

Venmo (Please enter username below)

Personal Check

Cash

Venmo Username (Leave blank if using a different payment method)

Phone Number *

Do you agree to receive text messages at this number? *

Yes

Address *

Select desired lesson frequency (30 minutes per lesson)
*

Weekly ($100 per month)

Other:

Do you give permission for student to appear in photos and/or videos that may be published on social media? *

Yes

Some busy families prefer not to reschedule a cancelled lesson, and would rather forego those lessons instead. What is your preference? *

Do not reschedule cancelled lessons, I would prefer to forego those lessons.

Please reschedule eligible cancelled lessons, and notify me of group classes and potential time slots as they become available.

Do you confirm that you have read and agree to my studio policies? (Click the following link to view. Please read carefully, as they have been changed and updated for the current year.)

Carolyn Emery Piano Studio Policies

Yes, I confirm that I have read and agree to Carolyn Emery Piano Studio Policies.

Please remember that my studio is also my family’s home. In consideration of that, please follow these simple rules:

Do not open the door yourself. Ring the doorbell or knock and wait for me to answer the door.

Please avoid using the driveway; it should remain clear for my family's use. You may use it for drop off and pick up ONLY during bad weather, then move on to the street if possible. Always carefully check to make sure the driveway is clear because my children often play outside.

Please remove your shoes and place them in the tray behind the door.

No food, drink, or gum allowed. (Please inquire about exceptions.)

Please reschedule if the student is feeling unwell and/or has a fever. No sick family members are allowed.

Parents and siblings are ONLY allowed if they sit quietly and do not cause a distraction to the teaching experience. Groups of 3 or more spectators are discouraged and should wait outside in their vehicle.

Do you understand and agree to abide by these rules?

Yes

Although the number of lessons received each month may differ, tuition is based on a set amount per year, and is broken into equal monthly payments.

The first month’s tuition will be charged at a rate of $27.50 per lesson if starting after the first week.

Students are responsible for the cost of books and supplies. I will provide the materials but require payment before they will be provided for use.

Tuition is due on the first day of every month. I accept Venmo (preferred), personal checks, and cash.

Do you understand and agree?

Yes

No credit or refunds will be given for missed or cancelled lessons, but I am more than happy to reschedule with a minimum of 6 hours notice.

Please do not come to the door before your scheduled time. Students should leave or be picked up promptly after the lesson has concluded.

It is the responsibility of the student/guardian to remember to attend lessons as I do not send out reminders. Excessive no-call/no-shows will result in being dropped as a client with no refunds given.

Do you understand and agree to abide by these terms?

Yes

All lessons that fall on Major Holidays, Spring & Winter Break, and Vacation dates will be cancelled. There may be additional “Studio Balance Cancellations” to keep tuition fair and balanced throughout my studio. These cancellations are not eligible to be rescheduled.

Do you understand and agree to these cancellations?

Yes

Do you agree to provide 30 days notice before taking breaks or discontinuing lessons, or to pay the applicable fees ($40 per student)? *

Yes

If you agree to these terms and conditions, please sign (type) your full legal name. If student is under 18 years of age, this is to be signed by their parent or legal guardian. *

Please provide any additional comments (previous experience, goals, reviews, etc.)

Thank you and I look forward to working with you!

A copy of your responses will be emailed to the address you provided.

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