Music Notes Academy New Student Registration

New Student Registration
$45 Per Student
The New Student Registration fee reserves your lesson day and time.

Section One: Student Information
Complete all applicable information, (*) denotes a required field.

Student's First & Last Name:*

Student's Date of Birth
(if under 18 years of age):

Student's Age:

Student's Home Address:*

Is off-street parking available for instructors?

Yes

Student's Email Address:

Confirm Email Address:

Student's Home Phone
Number(s):*

Student's Cell Phone
Number(s):

Session: When would you like to begin music instruction? See Calendar page for session dates.

Winter 2009

Spring 2009

Summer 2009

Fall 2009

At the beginning of next month

Immediately, upon availability

Section Two: Parent/Guardian Information
Adult Students Please Skip Section Two & Continue To Section 3

Mother's First & Last Name:

Mother's Home Address:

Mother's Daytime Phone Number:

Mother's Cell Phone Number:

Mother's Evening Phone Number:

Mother's Email Address:

Confirm Mother's Email Address:

Father's First & Last Name:

Father's Home Address:

Father's Daytime Phone Number:

Father's Cell Phone Number:

Father's Evening Phone Number:

Father's Email Address:

Confirm Father's Email Address:

Emergency Contact Information:
In case of an emergency, whom should
be contacted in the event a parent
cannot be reached?

Please Describe Any Special
Considerations Or Medical Conditions
Music Notes Academy Should Be
Informed With:

Section Three: Student's Musical Interests

Preferred Instrument of Study:*

Preferred Lesson Day & Time:*
*Lesson Day/Time Requests Cannot
Be Guaranteed*

Describe Musical Background and/or
Prior Experience:

Briefly Describe Your Musical Goals &
Aspirations:

Are You Interested In Performing With
Ensembles & Bands? If So, Please
Describe: Please visit our Classes page
for information on our new ensembles,
bands and group classes!

Describe, if any, learning/educational
disabilities:

Section Four: Questions & Comments

Questions & Comments:

How Did You Hear About
Music Notes Academy?*
(example: Google, Yahoo, specific
website such as
www.clickforlessons.com)

I understand to ensure students receive the most comprehensive and well-rounded music education,
students and parents are encouraged to adhere to the Academy policies. I have read Music Notes
Academy's Policy Statement on the Policies page and understand and agree to the terms and conditions
as outlined and described. I understand I will receive a personal and complete copy of Music Notes
Academy's Policies at or before the first music lesson.

Initial Here: (Parents please initial for
students under 18 years of age)

Promotional Code or
Referral Family Last Name:

When is the best time to speak with
the director? (morning, afternoon,
evening)

Would you like to receive a trial lesson?
Trial Lessons, based on instructor/director availability, are available for 30-minutes in length.
Trial lesson fee, $40, must be received before trial lesson appointment day, one (1) trial lesson per
student, no refunds for re-scheduling or cancellations - to re-schedule a trial lesson a new trial lesson fee
must be submitted.

Yes!

I would like to receive a trial lesson and I will submit $40 made payable to Music Notes
Academy. Submit Payment To: Music Notes Academy PO Box 8035 Bridgewater, NJ
08807-8035

No!

I am not interested in a trial lesson, I would like to begin music lessons!

Section Five: New Student Registration Payment Submission

New Student Registration Fee (non-refundable): $45
New Student Registrations are not official until payment is received.
Music lessons will begin only upon submission of Registration Fee.

Please Submit Payment To:
Music Notes Academy
New Student Registration
PO Box 8035
Bridgewater, NJ 08807-8035

Thank you for registering with Music Notes Academy!
You will be contacted within 48 hours by a representative.

Music Notes Academy Office: (908) 393.1418 Director's Mobile: (908) 938.0366

register for lessons in the student's home

Music Notes Academy, LLC
Learn Today, Play Tomorrow™
PO Box 8035
Bridgewater, NJ 08807-8035

Music Notes Academy Office: 908.393.1418
Director's Mobile: 908.938.0366

Website By Brandon Kurzawa for Music Notes Academy, LLC
Contact Webmaster

Reproduction of website content is strictly prohibited, contact Music Notes Academy for reprint permission.
Copyright © 2009 Music Notes Academy, LLC. All Rights Reserved.

Student Registration

Est. 2000

Using Your Gift
Certificate
Music lessons
scheduled with
gift certificates is
limited to
instructor
availability.
Requests will be
granted in the
order received
and gift certificate
recipients may
have to wait for
instructor
availability.
Make-Up lessons
are not available
for students who
use a gift
certificate for
music instruction
- upon official
student
registration,
students will be
eligible for
make-up lessons.
If student/parent
chooses to
register officially
as a student, gift
certificate(s)
amount(s) will be
applied towards
monthly tuition.
For more
information on
scheduling music
lessons with gift
certificates please
call to speak with
a representative.

How To Use A Gift
Certificate
Enter the
recipient's name
on the gift
certificate into the
Promotional Code
text field.

Music Notes Academy

Music Lessons: New students can register for music instruction at anytime throughout the school year or
summer months. Transfer students (students from other community schools, music education providers,
music stores and private music instructors) are encouraged to register for a trial lesson with the Academy's
Director for performance evaluation, assessment and proper instructor compatibility matching. Music
lessons occur weekly on the same day and time with an instructor in the student's home.

our online new
student
registration.

2. The Director will
personally contact you to
discuss your music
education and registration.

3. Submit your first month's
tuition statement before your first
scheduled music lesson and you
can learn today, play tomorrow™!