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?

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

	Piano
	Keyboard

How did you hear about us?

	Online search
	Facebook
	Referred
	School Flyer
	Sign
	Other

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

TUITION - Payments are processed by pre-authorized credit cards or auto-draft from checking accounts on the first of each month. Tuition is never prorated for missed lessons. Tuition does not include any retail teaching materials such as books or instruments. *

Click to indicate that you understand and accept

REGISTRATION FEE - A registration fee is due when enrolling and is non-refundable. Students who withdraw and return at a later time will be charged a new registration fee.*

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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. In the event of school closing due to severe weather, we will reschedule private lessons during a holiday break or designated weekend. For any lessons missed by the student, the Academy holds small group classes periodically. The classes are age and level appropriate. To sign up for a class, contact the office and not the instructor for a date and time. *

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DISCONTINUING LESSONS - Every student is on a month-to-month basis. To discontinue lessons and discontinue charges to your account, fill out the withdrawal form before the 15th of your last month. We do not prorate tuition for the last month of lessons. Students will be responsible for their last month of tuition whether or not they attend lessons. *

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AVERAGE OF FOUR LESSONS PER MONTH - Lessons occur on the same day and same time each week. Monthly tuition is based on an average of four lessons per month. We are closed four weeks each year for holidays. 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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SUMMER VACATION - Dallas Piano Academy operates year-round and does not close for the summer. We are happy to offer unlimited group makeups for our students. 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 before you leave or after you return from vacation. *

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OPEN DOOR POLICY - Please feel free to visit with your teacher regarding progress and assignments. Parents are always welcome to observe private lessons at any time. *

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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. Dallas Piano Academy is not responsible for any damage done to vehicles or any items stolen from vehicles. *

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PICKING UP - The school is not responsible for providing before or after care of students. Please be aware that the waiting room is not supervised. Please drop off students no more than five minutes prior to the lesson time and pick them up promptly. Children must wait for their parents to pick them up inside the Academy. Please do not ask them to meet you elsewhere. Students are not to be dropped off on the street or curb. The Academy assumes no responsibility for children who leave unaccompanied. *

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IMAGE & AUDIO/VIDEO RECORDING WAIVER - We sometimes include students on our websites, social media accounts, videos, brochures, promotional materials, advertisements, presentations, photographs, and for other business purposes. *

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

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