Music Lessons Express Registration Form* 
                         2007-08 School Year

  * Please note that registration is not complete until your registration fee and first month's lesson payment is received
          by the Music Lessons Express office.  Visit our home page for instructions on how to submit payment. 

  * Please Note that all Returning Students need to complete a registration form.  

Please provide the following information:
       (for Adult Students you may omit Parent/ Guardian name) 

Select the Music Lesson you would like to register for:

     SuperStar Singing!

     Group Guitar
     Private Guitar

     Group Piano
     Private Piano

     Private Flute      (available only at select locations, see home page for link with list) 

Choose Lesson Location: 

  Canopy Oaks
  Celebration Baptist After-school Program
  Cornerstone
  Desoto Trail
  East Hill Baptist (held at Sullivan Elementary School)
  Gilchrist
  Hawks Rise

  Home-Based Lessons
 
  Sullivan
  Trinity Preschool


 Is the student a returning student?   Yes No

 Is your child in the after-school program?  Yes No      If yes, list usual pick up time:  PM

 If your child is enrolled in other after-school activities on the lesson day, please list activity and time. 
   

 Is there a lesson time you prefer? PM

 If the student has any previous musical experience, please briefly describe.

     

  If the student has any medical conditions or other special needs, please describe.

     

  List persons and their relation to the student that are authorized to pick up the student after lessons.

Name	Relation

  How did you hear about our program?

    Display at School Orientation
    Outdoor Sign on School grounds
    Flyer from After-School Program
    Mailing from Music Lessons Express
     Other

  Do you have an instrument in your home for practice?   
      If yes, please describe the make, model and approximate price paid ("toy type instruments" are typically not 
             adequate for developing musicians) 
   Make, model, price paid:    
 
 
    If you currently do not have an instrument at home, you may enroll today, however our policy states that you should 
   obtain one within one month.  Without practice at home, developing musicians are easily frustrated and fall behind in class. 

   Any additional comments you may wish to make: 

  
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  Security Code (East Hill Baptist Students only)   
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  Parent/ Guardian/ Adult Student,  please initial boxes below to signify that you agree to the following: 
      If either of the first 2 boxes do not apply to you, please leave blank.
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 For students being dropped off for a lesson:   
   (including those not registered in the After-School Program on the lesson day)
   
  Parent/ Guardian please initial box to signify that you agree to the following:      

        I understand that I must escort my child to the music lesson room and then return to the room when the lesson 
               is over to sign my child out.                                                                                           
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For students enrolled in the first lesson after school: 

 Parent/ Guardian please initial box to signify that you agree to the following:   
         I give my child permission to walk from his/her classroom to the location of the lesson.      

 [Children in the After school program should check in with after school program prior to coming to music lessons.]                
       
        If you do  not agree to this please contact our office (850-219-3653) so that we may make alternate arrangements for 
         your child to get to class.                                                                                                                                                   
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For all students: 
Parent/ Guardian/Adult Student  Please type your name in the box to signify that you agree to the following:
                                                          
  I, (First and Last Name of Parent/ Guardian/ Adult student), have read and agree to the information and policies of Music Lessons Express.  Further, I understand there is an initial commitment of two months' lessons and that a 30-day notice for withdrawals is now in effect.  Upon request, lessons will be terminated at the end of any month, provided 30 days notice is given.  Please note that if a student stops coming to lessons with no notification, then the student will be charged for the current month plus the following month in order to fulfill the 30 days notification policy.  I understand that if lessons are not being attended and no withdrawal notification is given, then I am responsible for the current month, plus the following month’s payments.  I will not hold Music Lessons Express or its instructors liable for any accidental harm or injury caused to a student or  student’s property, or damage to school property caused by a student.  I understand that a monthly payment is due by the first  of the month and $5 late fee will be added to payments not received by the 10^th of the month.  I further understand that a payment reminder will be sent to my email address, but will NOT be mailed to my home address (except to those who do not  provide an email address on this registration form; they will receive invoices by mail).    

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   Amount Paid   $      
          
   Payment Method     on-line   check/money order      
                  
   Date payment made   (dd/mm/yy)
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   Remember that your enrollment is not finalized until the Music Lessons Express office has
   received your payment and registration fee.      




  Thank you for registering with us!