Register for MUSIC lessons

Register for piano lessons at Dallas Piano Academy by using this form:

New Student Questionnaire & Policy Agreement

Please note that all fields followed by an asterisk must be filled in.

Student Name*

Address*

Phone*

Email*

Student Birthday (month and day)

If student is a minor, please give name of parent/guardian

Student Grade in School (if applicable)

Student School (if applicable)

Has student taken music lessons before?

	Yes
	No

If yes, what instrument? How long?

Please list any music books you already own:

Does student have any medical history that we need to be aware of?

Do you have a specific goal for taking music lessons?

For piano lessons, what type of instrument do you have at home for practice?

	Acoustic Piano
	Digital Piano
	Portable Keyboard

How did you hear about Dallas Piano Academy?

	Online search
	Facebook
	Referred
	School Flyer
	Other

Referrals are important to us! If you were referred, please share who so we can thank them!

IMAGE & AUDIO/VIDEO RECORDING WAIVER*

Yes, I give permission for the image, audio and or video recording of myself to be used by the Dallas Piano Academy LLC. From time to time, Dallas Piano Academy LLC, a Texas limited liability company, including its parent, subsidiary, affiliated, and related entities, and our successors and assigns (collectively, the “Academy” or “us”) may desire to use the name, image, likeness, quotations, voice, performance, and/or other like identifying material of your child or children (collectively, “Identifying Material”) in connection with our websites, social media accounts, videos, brochures, promotional materials, advertisements, presentations, photographs, and for other business purposes. This may include, among other things, audio, video, and/or still images of your child’s (or children’s) lessons, recitals, and performances. In connection with this, you hereby grant us the unlimited, worldwide, perpetual, irrevocable, transferable, royalty-free license and right to use, reproduce, dis

No, I do not give permission for the image, audio and or video recording of myself to be used by the Dallas Piano Academy LLC

TUITION - Tuition is a flat rate, charged monthly, until canceled. Tuition is never prorated for missed lessons. Lessons falling during holidays and breaks listed in the Studio Calendar are included in the monthly rate and will not be credited or refunded. Tuition does not include any retail teaching materials such as books or instruments. *

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TUITION PAYMENTS - Tuition is due on the 1st of every month and is late after the 10th. A $20.00 late fee will be charged on the 11th. Insufficient funds will be charged an additional $25.00. After a second occurrence, future payments must be made in cash. If payment is not received by the last day of the month in which payment is due, lessons will be suspended.*

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AVERAGE OF FOUR LESSONS PER MONTH Monthly tuition is based on an average of four lessons per month. In some months, you will get five lessons and in short months such as November and December, you will get three lessons. However, most months you will get four lessons. The tuition is the SAME each month regardless of the number of lessons in that month, i.e. we don't charge you more for five lessons or less for months with three lessons in a month. This makes everyone’s accounting easier! *

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CANCELLATIONS AND MAKEUPS For any lessons missed by the teacher, the Academy will attempt to provide a substitute teacher. If a substitute teacher is unavailable, a makeup lesson with the teacher will be scheduled promptly. If you need to reschedule or cancel a lesson, please let us know as early as possible that you are cancelling your lesson or are needing to reschedule. “No-shows” will not be considered for makeups/rescheduling. *

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DISCONTINUING LESSONS To discontinue lessons and discontinue charges to your account, provide written notice or fill out the withdrawal form before the 15th of your last month. We do not prorate tuition for the last month’s lessons. Students will be responsible for their last month’s tuition whether or not they attend lessons. *

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SUMMER VACATION Dallas Piano Academy operates year-round and does not close for the summer. We are happy to offer makeups for our students by appointment. If you are taking a month off for vacation and want to resume the next month, your payment is still due on the first of the month to reserve your lesson space. The lessons for the month that you miss can be made up when you return from vacation. *

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INJURIES Parents, legal guardians of minors, students and adult students waive the right to any legal action for any injury sustained on school property resulting from normal lesson activity or any other activity conducted by the students or their siblings, before, during, or after lesson time, including hearing loss or hearing damage. The Dallas Piano Academy is not responsible for any damage done to vehicles or any items stolen from vehicles. *

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LESSON ARRIVAL/DEPARTURE If you arrive early, please wait outside in the car until it is time for your lesson. Students should be picked up promptly at the end of their as there may be another lesson starting or the teacher may need to leave immediately after the lesson. *

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PICK UP Dallas Piano Academy assumes no responsibility for children who leave unaccompanied. Please be prompt when dropping off and picking up students as waiting students cannot be supervised and there is no waiting room. *

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DIGITAL SIGNATURE CONFIRMATION - Type your name and the date here to confirm that you have read, understand, and agree to abide by these policies. *

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