Academic Year Registration Form 2019

Academic Year Registration Form 2019

Please fill in the form below completely. If you have questions please call 828 322 2694 or email hickorysuzukischool@gmail.com. We will contact you to let you know that we received it!
Suzuki School of the Arts is a 501 (C) 3 non profit organization that does not discriminate on the basis of race, sex, creed, national or ethnic origin, disability, or socioeconomic status.
Student Name*

First NameLast Name
Parent Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Number

Area CodePhone Number
Cell Number*

Area CodePhone Number
E-mail*
Student Age*
Student Birthdate*

MonthDayYear
Date
Student School and Grade Level
Student Instrument*
Violin, Viola, Cello, Guitar, Piano
Student Instructor
Please choose one
Preferred Lesson Time 1*
ex Monday at 7pm
Preferred Lesson Time 2
ex Tuesday at 4pm
Preferred Lesson Time 3
ex Friday at 5pm
Lesson Length*
Please choose one
Payment method*
Please choose one, Suzuki School accepts credit cards through PayPal and you will receive an email invoice.
Financial Agreement*

Financial Obligation I understand that my financial obligation to Suzuki School of the Arts is for the entire academic year, September through May. Should lessons be discontinued during that time, I agree to pay my tuition in full. I understand that if I default on my tuition payments, lessons will be discontinued and my bad debt will be sent on to a collection agency for payment.
Registration Fee*

I understand that my financial obligation to Suzuki School of the Arts will include a $10.00 per family registration fee, due with the first payment.
Participation Agreement*

I understand that participation in all private lessons, group lessons, workshops, concerts and other events will ensure the optimum success and and progress. Therefore I will make every effort to attend and participate in all activities of the school.
Photo Release check only one please*

I understand that the Suzuki School of the Arts may photograph and/or videotape any SSA function or event which my family attends. I hereby grant SSA my permission to use such photos or videos for educational, historical, or publicity purposes.I understand that Suzuki School of the Arts may photograph and/or record any SSA function in which my family attends. I DO NOT grant permission to use photos/videos containing me or my child for educational, historical or publicity purposes.
Agreeing to the provisions of this Enrollment Contract constitutes a legally binding agreement between you and Suzuki School of the Arts.
Optional Information

This gives us information about our community for recruiting members of our Board of Directors and grant information.
Mother Name

First NameLast Name
Mother Occupation
Mother Work Phone

Area CodePhone Number
Father Name

First NameLast Name
Father Occupation
Father Work Phone

Area CodePhone Number
Any additional information we need to know?
Should be Empty:

Academic Year Registration Form 2019

Optional Information