$140.00

4, 30-Minute Drop-in Lessons Registration

* Last Name

* Parent's Name

* Student's Name

* Student's Birth Month

* Student's Birth Day

* Student's Birth Year

* Medical Conditions * Medical Conditions Yes No

* Medical Description

* Instrument/Class

* Best Phone Number

Spouse's Name

Spouse's Phone Number

* Street Address

* City

* State

* Zip

* How you heard of us?

* Email Address

Spouse's Email Address

* I agree to North Main Music's Policies & Procedures below. * I agree to North Main Music's Policies & Procedures below. YES

North Main Music Policies and Procedures

Payment Of Fees: Tuition must be paid by automatic bank account debit or automatic credit card payment. Tuition will be debited from your bank account on the 1st day of every month. Tuition is non-refundable. Credit card or bank debit payments are not accepted for in-person payment on a monthly basis. Payment must be made by pre-authorized automatic monthly payment. All charges will appear on your bank statement or credit card statement as being from North Main Music.

NSF (Non-Sufficient Funds) Payments: I hereby authorize the school to electronically debit my bank account for the amount of any NSF paper check or auto-debit transaction plus a $25 NSF fee.

Withdrawal and Refunds: There is a one-month minimum for lessons. A one-month notice from the first of the month is required to discontinue any classes. Withdrawal must occur within the first 7 days of the month. All automatic debiting or credit card charges will stop after the one-month period.

Extreme Weather or Unexpected Interruption of Class: If your lesson is cancelled or you cancel due to inclement weather or events beyond our control such as power outages. Your class will take place online at it’s normal time online or a recorded video lesson will be provided. There will be no refunds or credits.

Teacher Absences: If a teacher misses a lesson, a make up will be arranged. The school reserves the right to provide a substitute teacher if the regularly scheduled teacher is ill or otherwise unable to teach the class.

Make Up Lesson Policies: In the event that a student is absent we do not offer mandatory makeup lessons. A video lesson will be provided at your normally scheduled lesson time and emailed to you the same day.

Holidays: North Main Music is closed for the following annual holidays: Memorial Day, Labor Day, Independence Day, Thanksgiving, and Christmas Day. Makeups are not offered for these Holidays.

Injuries: Parents, legal guardians of minor students and adult students waive the right to any legal action for any injury sustained on school premises resulting from any normal lesson activity before, during or after class time.

Permission to use IMAGES/PICTURES: I hereby give North Main Music LLC the absolute right and permission to publish images/pictures of me for PROMOTIONAL PURPOSES in which I may be included in whole or in part. If the person photographed is under 18, I certify that I am his or her parent or legal guardian and I give my consent withour reservation to the foregoing on his or her behalf.

Permission to use VIDEO IMAGES: I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the internet.There is no time limit on the validity of this release nor is there and geographic limitation on where these materials may be distributed. I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.