2022 Summer Lesson Registration
Daniels Music Studio / Summer Lesson Registration
Student Name ________________________________
Mailing Address _______________________________
City_________ State___ Zip _______
(If under 18 years of age)
Parent 1) _________________________________________
Email ______________________ Phone ________________
Parent 2) _________________________________________
Email ______________________ Phone ________________
(for all students)
Emergency Contact (name, relation & phone)
____________________________________________________________________
Check ONE payment option:
__One-time Payment __A la carte (minimum of 3 lessons)
Do you plan on registering for 2022/2023 Term? __ yes __no
Acknowledgment of Studio Policies: By signing below, I/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. I/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 also acknowledge that our tuition is non-refundable and make up lessons are not guaranteed. I/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 the student’s name (first & last) in conjunction with photographs &/or videotape.
____________________ ____________________
Student Signature & Date Parent Signature & Date
(if student is under 18 years of age)
Student Name ________________________________
Mailing Address _______________________________
City_________ State___ Zip _______
(If under 18 years of age)
Parent 1) _________________________________________
Email ______________________ Phone ________________
Parent 2) _________________________________________
Email ______________________ Phone ________________
(for all students)
Emergency Contact (name, relation & phone)
____________________________________________________________________
Check ONE payment option:
__One-time Payment __A la carte (minimum of 3 lessons)
Do you plan on registering for 2022/2023 Term? __ yes __no
Acknowledgment of Studio Policies: By signing below, I/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. I/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 also acknowledge that our tuition is non-refundable and make up lessons are not guaranteed. I/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 the student’s name (first & last) in conjunction with photographs &/or videotape.
____________________ ____________________
Student Signature & Date Parent Signature & Date
(if student is under 18 years of age)