Child Piano Registration
Printer Friendly Child Piano Registration.pdf
Date________________________________________
Student’s Name___________________________________________ Age_____________
Mother’s Name ___________________________ Cell Phone Number______________
Father’s Name____________________________ Cell Phone Numbers______________
Address_________________________________________________Phone Number_______________
Email ________________________________________________________
Birth date___________________________________________
School______________________________________________Grade__________________________
Please list any personal circumstances of which as a teacher I should be aware (Learning disability, health concerns) ___________________________________________________________
___________________________________________________________________________________
Age and Number of Siblings in your home_______________________________________________
Father’s Employment_____________________________________Phone Number_______________
Mother’s Employment____________________________________Phone Number_______________
Brand and Age of Piano_______________________________________________________________
How often is your piano tuned________________________________________________________
Length of planned practice time______________Days unable to practice_____________________
MAKE-UP LESSONS WILL NOT BE GIVEN FOR LESSONS MISSED BY THE STUDENT.
You may trade lessons with other students.
If you would like for your phone number to be included on the “Lesson Swap List”, please list the phone number you would prefer listed. _________________________________________________
We have read and discussed your STUDIO POLICY and ‘Schedule of Fees’ and agreed to honor them:
Mother’s Signature________________________________________________________________
Father’s Signature_________________________________________________________________
Student’s Signature________________________________________________________________
Disclaimer of Liability
Parents should recognize that the teacher, Karen Kay Reed, cannot and does not supervise students who arrive early or who remain after lessons. In particular those areas outside of the piano and immediate teaching area such as but not limited to front yard, back yard, porches, steps, etc. are not supervised by the teacher. Parents of students are encourages to attend all lessons and supervise their children immediately before and after lessons.
The studio of Karen Kay Reed disclaims responsibility for a harm, injury or accident experienced by a student, relative or friend of student on Karen Kay Reed property.
Parents Signature Section
Mother___________________________________Father____________________________________
Parents of student __________________________________________have read this disclaimer and agree that it is our sole responsibility to supervise their child and other accompanying children. I agree that Karen Kay Reed will not suffer any liability for the consequences of parental failure.