Registration Form

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REGISTRATION FORM

To register for classes online, please type in the information below and click "SUBMIT REGISTRATION FORM" on the bottom of this page. This puts you on the class list immediately. Enrollment cannot be guaranteed until the class fee is paid. Click "CONTINUE" after the form has been submitted and you will be directed to the online payment page. You can also print out this form after typing in the information OR print out this form first and complete it manually. The form can then be mailed or dropped off at THE PIANO STUDIO at 7840 El Cajon Blvd., Suite 402, La Mesa, CA 91942-0619. There is a mail slot right at the door in Suite 402. Your signature is required. Please use one form per student.

Last Name
First Name Middle Initial
Gender Male     Female
Birth Date / /
Street Address Apt. No.
City Zip Code
E-mail Address
Cell Phone ( ) -
Home Phone ( ) -  
 
LIST THE COURSES YOU WANT TO TAKE
Course # Course Title         Fee
1 $
2 $
  Total Enclosed: $


PLEASE SUBMIT PAYMENT WITH YOUR REGISTRATION TO GUARANTEE ENROLLMENT.

Credit and debit cards are accepted. Please submit the completed registration form FIRST and click "CONTINUE" to direct you to the online payment page. If using US Mail or dropping off registration at The Piano Studio when it is closed, please pay by check. DO NOT MAIL CASH or DROP OFF CASH when the studio is closed.
Your signature is required regardless of payment method and signifies you have read the Liability Waiver.
Payment:
Cash           Check (Payable to Sam Yip)        
Credit or Debit Card                                                                                          

Liability Waiver: By signing below, the student agrees that neither THE PIANO STUDIO nor its instructors shall be liable for any and all injuries, loss, and other damages that may be suffered by reason of voluntary participation in class activities. The waiver is effective as long as the student is taking classes or lessons at the studio. No refunds or credits after the second class unless the class is canceled by administration. A minimum of 48-hour notice is required to reschedule private lessons. Your signature is required below. You may type in your signature. Thank You!


Your Signature:       

   

I consent to my child taking lessons at The Piano Studio and
I have read the Liability Waiver above.
Parent’s Signature:  
(For students under 18)       
Date:    
 


Date:

 
PLEASE IGNOR the survey or ads offered by the server and click "Continue" following the words "Form Sent" on the upper right hand corner of the page after the registration form
has been submitted. This will direct you to the online payment page. Thank you!