Student Enrollment Form
Please print and fill up this form. Mail it to Vivace Music Academy, 312 Whitworth Avenue South, Renton WA 98055.
Program MusicGarten ___Baby time __ Toddler Time ___Cycle of Seasons ___ Music Makers
Piano Adventures __Primer __ Level 1 __Level 2A __ Level 2B __Level 3A __ Level 3B
Junior Piano Adventures ___Accelerated 1 ___Accelerated 2
Adult FunTime ___ Adult 1 ___Adult 2 ___Adult 3 ___ Adult 4
Royal Conservatory of Music Level _____
General Information (*required information)
Student Name* _____________________ Parent (children only)_________________
Age (children only) ____ Birthday (children only) ____________________________
Mailing Address* ___________________________________________________________________
Street Apartment #
_____________________________________________________________________________
City State Zip Code
Home Phone* ( ) - Other Phone ( ) -
E-mail Address _________________________ School__________________________
In the event of emergency please contact: Name ___________ Phone_____________
Instruction and Instrument
Student has studies piano for ____ years/months.
Other instrument(s) studied ______________________
Previous teacher(s) name _____________________
Instrument(s) owned
__ Acoustic Piano __Digital Piano ___Keyboard __Music Tutor __ Grand Piano
Brand and make_______________________________________________
Is the student involved in any music group(s)?__________________________
Additional activities students involved on a regular basis_________________________
Please initial:
____ All students are required to submit a non-refundable registration form and pay a registration fee of $25.00 per student or $45.00 per family.
____ Semester tuition is due at the first week of instruction. You can split the tuition into two equal payments. Tuition can also be paid on a monthly basis. If you elect the monthly option, tuition for the first and last month is required upon enrollment. A $15.00 late fee is added to account not paid by the 15th of the month unless a prior arrangement has been made with the teacher. Return check fee is $25.00. Three returned checks will result in cash or money order payment.
____ There will be no refund for missed lessons. Teacher absence or other Academy cancellation will lead to an extension of the quarter except in the case of inclement weather. There will be no make-up lessons for group piano students. Private piano students should consult their principal teacher regarding his or her make-up policy.
____ All students in Music for Little Mozarts, Piano Adventures, Junior Adventures and Adult Fun Time are highly recommend to practice with an MT-90. You can purchase or rent the equipment from Prosser Piano and Organ.
____ If for any reason I decide to withdraw from the studio, I agree to give four weeks tuition paid notice, I and will pay in full for materials given to me.
_________________ ________________ _______________ _____________________ Parent/Student Signature Administrator Signature Principal Teacher Date Sign