GENERAL INFORMATION

Name You Would Like To Have On The Account: 

Address: 

City:      State:              Zip: 

Home Tel with Area Code: (ex: (123) 456-7890)

Work Tel with Area Code: (ex: (123) 456-7890)

Cell with Area Code: (ex: (123) 456-7890)

Fax with Area Code: (ex: (123) 456-7890)

Other Tel with Area Code: (ex: (123) 456-7890)

E-mail address (*required):  IMPORTANT: We will email your invoices to this email address.  Please be sure to add prestigemusicstudios.com to your "safe senders domain" list so the invoices do not go to junk mail.  If you need to receive paper invoices in the mail, there is a $2 per invoice service charge.  If you need this service, please check here.

With whom have you spoken or met regarding lessons?  

Are you a member of Angie's List, Cleveland?     Choose one... Yes No

Where did you hear about us?

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

STUDENT INFORMATION

STUDENT 1

Name: 

Age:      D.O.B.:  (MM/DD/YYYY)

Instrument - hold down the shift or ctrl key to make multiple selections:                                

               Brass Instrument (Trumpet, Trombone, etc.) Guitar: Acoustic Guitar: Electric Guitar: Suzuki (suggested for children under 8yo) Percussion (drumset, etc.) Piano: Private, Suzuki (suggested for ages 3-8yo) Piano: Private, Traditional Songwriting Strings, other than violin Studio Program (1-3 hrs weekly of private dance, drama, and/or voice) Theory Violin: Suzuki (suggested for students of all ages) Violin: Traditional Voice Woodwinds (Flute, Clarinet, Sax, Oboe, etc.)

Number of Lessons Per Week:  Choose one... 2x/wk, suggested for ages 3-5 2x/wk 1x/wk

Prior experience on instrument(s):

The suggested lesson length will be assigned to the student.  If you prefer otherwise, please state and explain here:

     Leave blank if suggested lesson length is acceptable.

Where do you prefer to have your lessons?   In home

Availability for lessons – Please give the start and end time each day when you are available for lessons.  We offer lessons on the following days and times: Monday - Friday, 9am-9pm; Saturday, 9am-4pm; regular lessons are not scheduled on Sundays.

If you have additional students to register, please do so below.  You may register up to 4 students on this form, or submit another form to register more than 4 students.  If you have completed the student information, please continue to the end of the form.

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 

STUDENT 2

Name:

Age:      D.O.B.: (MM/DD/YYYY)

Instrument - hold down the shift or ctrl key to make multiple selections:                                

     Brass Instrument (Trumpet, Trombone, etc.) Guitar: Acoustic Guitar: Electric Guitar: Suzuki (suggested for children under 8yo) Percussion (drumset, etc.) Piano: Private, Suzuki (suggested for ages 3-8yo) Piano: Private, Traditional Songwriting Strings, other than violin Studio Program (1-3 hrs weekly of private dance, drama, and/or voice) Theory Violin: Suzuki (suggested for students of all ages) Violin: Traditional Voice Woodwinds (Flute, Clarinet, Sax, Oboe, etc.)

Number of Lessons Per Week:  Choose one... 2x/wk, suggested for ages 3-5 2x/wk 1x/wk

Prior experience on instrument(s):

The suggested lesson length will be assigned to the student.  If you prefer otherwise, please state and explain here:

     Leave blank if suggested lesson length is acceptable.

Where do you prefer to have your lessons?   In home

Availability for lessons – Please give the start and end time each day when you are available for lessons.  We offer lessons on the following days and times: Monday - Friday, 9am-9pm; Saturday, 9am-4pm; regular lessons are not scheduled on Sundays.

If you have additional students to register, please do so below.  You may register up to 4 students on this form, or submit another form to register more than 4 students.  If you have completed the student information, please continue to the end of the form.

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

STUDENT 3

Name:

Age:      D.O.B.: (MM/DD/YYYY)

Instrument - hold down the shift or ctrl key to make multiple selections:                                

      Brass Instrument (Trumpet, Trombone, etc.) Guitar: Acoustic Guitar: Electric Guitar: Suzuki (suggested for children under 8yo) Percussion (drumset, etc.) Piano: Private, Suzuki (suggested for ages 3-8yo) Piano: Private, Traditional Songwriting Strings, other than violin Studio Program (1-3 hrs weekly of private dance, drama, and/or voice) Theory Violin: Suzuki (suggested for students of all ages) Violin: Traditional Voice Woodwinds (Flute, Clarinet, Sax, Oboe, etc.)

Number of Lessons Per Week:  Choose one... 2x/wk, suggested for ages 3-5 2x/wk 1x/wk

Prior experience on instrument(s):

The suggested lesson length will be assigned to the student.  If you prefer otherwise, please state and explain here:

     Leave blank if suggested lesson length is acceptable.

Where do you prefer to have your lessons?   In home

Availability for lessons – Please give the start and end time each day when you are available for lessons.  We offer lessons on the following days and times: Monday - Friday, 9am-9pm; Saturday, 9am-4pm; regular lessons are not scheduled on Sundays.

If you have additional students to register, please do so below.  You may register up to 4 students on this form, or submit another form to register more than 4 students.  If you have completed the student information, please continue to the end of the form.

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

STUDENT 4

Name:

Age:      D.O.B.: (MM/DD/YYYY)

Instrument - hold down the shift or ctrl key to make multiple selections:                                

      Brass Instrument (Trumpet, Trombone, etc.) Guitar: Acoustic Guitar: Electric Guitar: Suzuki (suggested for children under 8yo) Percussion (drumset, etc.) Piano: Private, Suzuki (suggested for ages 3-8yo) Piano: Private, Traditional Pre-Modeling/Etiquette/Polishing Coaching or Summer Camp Songwriting Strings, other than violin Studio Program (1-3 hrs weekly of private dance, drama, and/or voice) Theory Violin: Suzuki (suggested for students of all ages) Violin: Traditional Voice Woodwinds (Flute, Clarinet, Sax, Oboe, etc.)

Number of Lessons Per Week:  Choose one... 2x/wk, suggested for ages 3-5 2x/wk 1x/wk

Prior experience on instrument(s):

The suggested lesson length will be assigned to the student.  If you prefer otherwise, please state and explain here:

     Leave blank if suggested lesson length is acceptable.

Where do you prefer to have your lessons?   In home

Availability for lessons – Please give the start and end time each day when you are available for lessons.  We offer lessons on the following days and times: Monday - Friday, 9am-9pm; Saturday, 9am-4pm; regular lessons are not scheduled on Sundays.

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Do you have any coupons or specials that encouraged you to register today?  If so, please describe here which one you have by using the appropriate coupon code.  Coupons are not accepted after this registration form has been submitted. If you wish to use a coupon, please complete the Specials Agreement and return it with your registration payment and before lessons begin. 

     $10 off the first month of lessons when registering and paying the $25 registration fee before June 1, 2008

Please type your initials here to confirm that you have received, read, and understand Prestige Music Studios, Inc.'s policies regarding all operations including attendance, billing, what we offer, our orientation and welcome program, our year, lesson lengths, tuition, service area and extended service area, Suzuki group lessons, canceling and rescheduling lessons, studio closures, student injury, recitals and performance classes, books and music, etc.            

PAYMENT INFORMATION

Your registration is NOT confirmed until payment is received. Please select your preferred method:

  TO PAY BY CHECK: Check # of your registration payment

          Mail the payment to: Prestige Music Studios, Inc., RE Registration Fee, 46 Village Pointe Drive, Powell, OH 43065

          The in-home registration fee is $25 per family.

  TO PAY BY CREDIT CARD: Call 6888.58.PRESTIGE x704 for the billing department. We accept Visa or MasterCard. Please be sure to include the following in your message:

          - the name on the card, and the spelling, stated slowly and clearly;

          - the credit card number and expiration date;

          - the address, city and zip code where your bill or statement is received; and,

          - the V-Code, or the last 3 digits on the back of your card.

Please also confirm the amount to be charged to your card. If you have any questions, please contact us and resolve those issues prior to giving us your credit card information. A confirmation will be emailed or mailed to you upon processing your credit card.

          NOTE: We will only be charging the registration fee to your card. We will invoice you for tuition. If you wish to pay by credit card monthly, please request the form for the Prestige Convenience Package and we will gladly forward it to you.

Please note: Prestige Music Studios does not process your registration form, assign a day, time, and instructor, or otherwise begin your lessons until the registration fee payment is received.

Additional comments or questions:  If you do not want to begin lessons immediately, please be sure to include your preferred start date here.  You may also wish to explain preferences in instructors, disabilities the student has, special gifts, personality traits, learning styles or previous music or performing experience.

We thank you for