Form of student information and policy agreement

                                                     Finger Lakes Piano Music Studio

Student Name: _____________________________________________________                            

Date of Birth:_______________________________________________________

Place of work, occupation:______________________________________________

Parents: ___________________________________________________________

Parents' employment, occupation:_______________________________________

Home address: _____________________________________________________

Home phone: _______________________; Mobile: _______________________

Email address: _____________________________________________________

Lesson Time: ______________________________________________________

tuition for  ___ 45-minutes  ___ 60-minutes for _________/per month

Start time:_____________________End time:_____________________________

I allow my video performance put on the Studio's website, YouTube or Facebook's studio page ----------

Piano Lesson Agreement

   I have received and carefully read through Finger Lakes Piano Music Studio Policy. I will be responsible for monthly payment. I will obey the studio policy for the late fee, missed lesson, cancellation notice and my responsibilities to my child. I would like my child to take piano lessons from Mrs.Natalya Hennings and understand the terms of this agreement.

________________________________        ________________________________

Parent Name (please print)                                 Parent Signature

________________________________        ________________________________

Student Name (please print)                                 Student Signature