Student Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Student Phone #

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Mother's Name *

First Name

Last Name

Mother's Phone *

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Father's Name *

First Name

Last Name

Father's Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

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Agree to Michelle Vincent’s Piano Studio Policy… *

I agree to pay Michelle Vincent, doing business as Michelle’s Musical Keys the annual tuition and any music charges according to the payment plan I have selected above for September, 2024 through May, 2025. I understand that I will owe a $20 late fee for a payment submitted after the 10th of the month. A re-enrollment fee of $40 applies if a student stops lessons in the middle of the school year or is absent for 4 consecutive weeks or more. I have read and understand the Studio Policies, and agree to abide by the guidelines and policies listed. I also understand that if my child wants to quit piano lessons before the end of the course, May 2025, my child’s lessons will not be officially terminated until I notify Michelle’s Musical Keys in writing of our termination and I agree to pay for tuition through the end of the month in which we notify of termination (even if my child has attended no lessons that month).

I agree