Capital Music Registration Form

Please choose a lesson type:
Adult Child (4-6) Child (6-17) After School at Kiker After School at Hill After School for St. Francis Drums
Student Name Birthday Grade School
Address City State Zip
Home Phone Cell Phone Email
Parents: Same household? Yes No
Mom's Name Employer Work Phone
Dad's Name Employer Work Phone
Emergency Contact (not spouse) Phone
How did you hear about us?

Fees

Registration Fee: $25.00; Materials Fee: Music books and materials are selected and charged as needed. Students will need materials to start lessons and as students progress and grow musically, they will naturally need more books to continue this progress.
Monthly Tuition: $125. [Tuition discounts available: a) when you rent from Capital Music Center (CMC), you will receive an $10 credit toward the rental of the required Roland Music Tutor or a Roland Piano with built-in Tutor; b) when you purchase from CMC a Roland Music Tutor or Roland Piano with built-in Tutor, your monthly tuition is $115; c) monthly tuition is $115 for each additional family member. Note: Tuition will not increase nor will you owe another registration fee as long as you remain a continuous student.]

Payments

Monthly auto-charge ATM/credit/debit or check card required to be on file for materials/tuition/tutor payments.

Enrollment Policy

For Capital Music Students: I agree to a 4 month or semester's commitment for my child/self. Withdrawl from lessons requires a 30-day written notice.
For After School Piano Students: I agree to commit my child to piano lessons for the remainder of the school year (May 31). {Exception: You may give notice by Dec 1 to drop the upcoming Spring Semester (Jan-May)}.
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Attendance Policy

Regular attendance is necessary for musical growth. Make ups for absences(illness, travel, choice, etc) are not available because of teacher's schedules. Please contact teacher for missed assignments. Teacher absences will be made up or a discount in tuition will be applied. Tuition due the 1st of each month, late fees for late payments. If tuition is ever pro-rated it is pro-rated at $37.50 per lesson. I understand that I am permitted to watch my child's lesson if I so choose. I also understand that Capital Music Center is not responsible for any unattended children before, during, or after lessons. If I choose to drop off my child for their lesson, I will be at the store/school promptly at the end of the lesson to pick up the child. I will ensure that any children under my care are supervised at all times. Summer lessons can be scheduled around vacations and breaks; includes your choice of two camps and two lessons, one camp and six lessons, or ten lessons. After school piano students are not required to take lessons during the summer, but the same options are available.
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Required Equipment

FOR PIANO: An 88 note piano with fully weighted hammer action, preferably a digital, is needed to take piano lessons. Acoustic pianos should be tuned every 6 months. Please indicate what you have:
Keyboard Digital Acoustic Upright Acoustic Grand
Brand & Model Age
I am interested in purchasing or renting a Roland digital piano from Capital Music Center.
FOR DRUMS: A drum set, preferably digital is needed to take drum lessons. Drum set should be in full working order. Please indicate what you have:
Brand & Model Age
I am interested in purchasing or renting a Roland V-Drum Set from Capital Music Center.
Good Set TD-4K2 $39/mo Better TD-4KX2 Mesh $49/mo
Best Set TD-9K2 Mesh $59/mo Ultimate TD-9KX2 Mesh + Upgraded High Hat, Snare, and Toms $99/mo
MUSIC TUTOR: If you do not already have one, a Roland Music Tutor will be provided as part of our lesson program for in-home practice and success. If lost or damaged, you will be charged a replacement fee of up to $599. If not returned within 7 days after last lesson, you will be charged a rental fee of $20 per month, including summer months.

Lesson Scheduling:

Please check off three or more best times and days you are available for lessons as well as what type of lessons you are interested in.
Private Piano Group Piano Best Available Piano
Private Drums Group Drums Best Available Drums
Monday Tuesday Wednesday Thursday Friday Saturday
10-1110-1110-1110-1110-1110-11
11-1211-1211-1211-1211-1211-12
12-112-112-112-112-112-1
1-21-21-21-21-21-2
2-32-32-32-32-32-3
3-43-43-43-43-43-4
4-54-54-54-54-54-5
5-65-65-65-65-65-6
6-76-76-76-76-76-7
I acknowledge the terms and receipt of this agreement.
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