Register Online-Codington Music Studio:Piano Lessons Near Me

New Student Registration

New Student Questionnaire

Once you have submitted your registration, we will contact you to schedule your first lesson date and time.

Student Name(Required)

First Last

Age(Required)

Additional Student Name

First Last

Age

What is the most important skill or song that you or your child would like to learn how to perform?(Required)

What is your (or your child’s) favorite kind of music?(Required)

Do you want or do you want your child to perform in our recitals? (they are LOW PRESSURE and 100% OPTIONAL!)(Required)

Do you or your child want to learn how to read music?(Required)

Do you or your child want to learn theory?(Required)

Do you or your child want to learn how to improvise (jam)?(Required)

What are your 6 month goals?(Required)

What are your 12 month goals?(Required)

We realize that everyone is here for intensely personal reasons. Please let us know why you or you child is here and what we can do to make sure that you learn what you want to learn. What do you or your child want to learn?(Required)

Comments

New Student Enrollment Form

How did you hear about Codington Music Studio?(Required)

Today's Date(Required)

Student Name(Required)

First Last

Student Birthdate(Required)

Male/Female/Other(Required)

Additional Student Name

First Last

Student Birthdate

Male/Female/Other

Parent/Guardian Name(Required)

First Last

Home Address(Required)

Street Address City State ZIP Code

Primary Contact Phone Number (this number will receive lesson reminders and scheduling updates)(Required)

Name(Required)

Can this number receive texts?(Required)

Yes

Secondary Number

Name

Can this number receive texts?

Yes

Email(Required)

Secondary Email (if any)

Emergency Contact Information

Emergency Contact #1(Required)

Relationship(Required)

Cell Phone(Required)

Work Phone

Emergency Contact #2

Relationship

Cell Phone

Work Phone

Image and Audio/Video Recording Waiver

At Codington Music Studio, we videotape and photograph recitals occasionally. In our monthly newsletter we feature students, videotape/photograph students for social media and our web site. If you would like for you or your child to participate in recitals, our newsletter or website, please answer "Yes" on this image and video/audio recording waiver.

Answer Below(Required)

Yes, I give permission for the image, audio and or video recording of my child, to be used by Codington Music Studio

No, I do not give permission for the image, audio and or video recording of my child, to be used by Codington Music Studio

Sign here after completing Image and Audio/Video Recording Waiver:(Required)

First Last

Date(Required)

Policies and Procedures

Sign here that you have read, understand, and agree to abide by these policies:(Required)

First Last

Date(Required)

Authorization Agreement for Payment

Payments are recurring and are deducted on the first of each month until a withdrawal form is submitted to the Studio. Withdrawals are due by the 15th of your final month to prevent charges on the following month.

Payment Method(Required)

Auto Draft from Checking Account (submit voided check)

Auto Draft from Credit/Debit Card

Sign here after reading policies, payment authorization and waivers.(Required)

First Last