Daniels Music Studio
2022/2023 Registration
Fill out the registration below & return with payment. Contact Nikkol if you plan to register more than one student
Name ______________________________Birthdate (month & day) _____________ Age____ Grade ____
Check ___ if home schooled Name of School______________________________________________
Mailing Address ____________________________ City____________________ State_____ Zip ________
Parent 1) _______________________Email _________________________ Phone____________________
Parent 2) _______________________Email _________________________ Phone____________________
Emergency Contact (name, relation & phone)__________________________________________________
Check ONE payment option: ___ Year (Sept.-June) __ Year (Jan.-June) __Monthly
*if you choose monthly, 2 payments are required with registration which is for your 1st & last month of lessons --- this does NOT go towards 2 consecutive lessons
Check days & times that work for you
__Mondays __Tuesdays __Wednesdays: __6 pm __7 pm __ 8 pm
Do you plan on registering for 2023 Summer Lessons? ___Yes ___No
Acknowledgment of Studio Policies
By signing below, we acknowledge we have read and agreed to the policies established by Daniels Music Studio / Nikkol Daniels and that they are not liable for injuries sustained on, in or around the premises. We understand that failing to follow these policies will limit our success and end our association with Daniels Music Studio. We acknowledge our financial responsibilities to Daniels Music Studio and acknowledge that our tuition is non-refundable and private make up lessons are not guaranteed. We __give __ do not give permission for the above-mentioned student's picture and/or video to be taken for promotional use, studio website, music association website and/or programs used only by the studio and music teacher. This authorization __includes __does not include to utilize my child's name in conjunction with photographs &/or videotape.
____________________________________ ____________________________________
Student Signature & Date Parent Signature & Date
(student may print if under 12)
2022/2023 Registration
Fill out the registration below & return with payment. Contact Nikkol if you plan to register more than one student
Name ______________________________Birthdate (month & day) _____________ Age____ Grade ____
Check ___ if home schooled Name of School______________________________________________
Mailing Address ____________________________ City____________________ State_____ Zip ________
Parent 1) _______________________Email _________________________ Phone____________________
Parent 2) _______________________Email _________________________ Phone____________________
Emergency Contact (name, relation & phone)__________________________________________________
Check ONE payment option: ___ Year (Sept.-June) __ Year (Jan.-June) __Monthly
*if you choose monthly, 2 payments are required with registration which is for your 1st & last month of lessons --- this does NOT go towards 2 consecutive lessons
Check days & times that work for you
__Mondays __Tuesdays __Wednesdays: __6 pm __7 pm __ 8 pm
Do you plan on registering for 2023 Summer Lessons? ___Yes ___No
Acknowledgment of Studio Policies
By signing below, we acknowledge we have read and agreed to the policies established by Daniels Music Studio / Nikkol Daniels and that they are not liable for injuries sustained on, in or around the premises. We understand that failing to follow these policies will limit our success and end our association with Daniels Music Studio. We acknowledge our financial responsibilities to Daniels Music Studio and acknowledge that our tuition is non-refundable and private make up lessons are not guaranteed. We __give __ do not give permission for the above-mentioned student's picture and/or video to be taken for promotional use, studio website, music association website and/or programs used only by the studio and music teacher. This authorization __includes __does not include to utilize my child's name in conjunction with photographs &/or videotape.
____________________________________ ____________________________________
Student Signature & Date Parent Signature & Date
(student may print if under 12)