New Student Information Form

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Date of inquiry: *

Students' Name: *

Students’ Date of Birth: *

Students’ School or Occupation: *

POC (point of contact) First & Last Name: *

POC Phone Number(s): *

POC E-mail address(es): *

Interested in taking lessons for: (Check all that apply) *

Vocals

Acoustic Guitar

Electric Guitar

Bass Guitar

Keyboard/Piano

Drums

Other:

Required

Interested in: *

30 minute lesson weekly (best for younger or less experienced students)

60 minute lesson weekly (best for older or more experienced students )

Other

Other:

Required

1st Choice Day: *

1st Choice Time: *

2nd Choice Day *

2nd Choice Time: *

3rd Choice Day *

3rd Choice Time Frame: *

We do our best to accommodate your day/time preferences. If you have alternative or additional preferences, please include details in the space below. *

If our roster is momentarily full, would you be interested in being placed on our waiting list? *

Yes

Lesson Reservation and Billing Policy *

All reoccurring lesson reservations are auto-billed every 4 weeks, for which reason a card must be linked to your account. No show or missed lessons are NOT deducted from your bill. Occasionally a make up lesson can be if coordinated in advance, but cannot be guaranteed due to the volume of students we maintain. If a reservation needs to be cancelled for an extended period, the lesson slot will be made available to the next student on the waiting list.

Reoccurring lessons are billed at a 15% discount to our standard hourly rate in order to accommodate absences. If the student misses less than 15% of their lessons, a separate invoice may be provided at the end of the calendar year for the remaining balance (not to exceed $200 for a standard weekly 0.5 hr reservation).

I have read and understand this policy.

How did you hear about us? Please provide individual reference if applicable.

Is there any additional information that you would like to provide about your student?

Are there any allergies your student may have that we need to be aware of?

Thank you for your interest in being a part of our community at Barnard Music. We look forward to working with you!

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