fpcmusic&Arts insti tute first presbyterian church | MARIETTA, ga
2017-2018 Music & Arts Registration Form Student’s Name (First, Last): Date of Birth: Instrument: (circle one) Piano | Violin
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Teacher: Marcela Meeks (Piano) | Will Myers (Violin)
Preferred lesson day (please circle one) Tuesday Thursday Friday *Saturday *Sunday *(limited availability) Preferred Lesson Time:
Preffered Start Date: ______________
Length of Lesson (please circle one, price of first 4 lessons included): Beginner Intermediate Advanced 30 minutes 45 minutes 60 minutes ($120) ($160) ($200) The rate for private instruction is $30 per 30-minute lesson, $40 for 45-minute, or $50 for 60-minutes. There is an annual $20 registration fee per student that is charged upon registration. We welcome students of all ages and encourage everyone to apply. Tuition for the first 4 lessons is due with registration. If you choose to pay monthly installments, it is your responsibility to do so by the 5th of each month. **You will not be billed every month.**
2017-2018 Music & Arts Registration Parent/Guardian Information Parent/Guardian(s): ___________________________________________________________________________ Street Address: ______________________________________________________________ City: ___________________________ State: _______ Zip: _______________ Best Phone Number: Home Cell _____________________________ E-mail Address: _____________________________________________ *I give permission for the Music & Arts Institute to publish photographs of my child or myself for promotional purposes.
Yes, I give permission No, I do not give permission
Emergency Contact Information Name/Relation to Student:____________________ Phone Number: ____________________________ Additional Information (use this space to list previous experience, if any, or any additional information you would like us to know): ____________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
Please return this form either in person or electronically to: Will Myers, Music & Fine Arts Coordinator 189 Church St. | Marietta, GA | 30062
[email protected]
