LESSON REGISTRATION FORM

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Welcome to Capstone Music.

You are committing to ongoing lessons which are pre-paid monthly based on the calendar month. We accept Visa, MasterCard as well as post-dated cheques. Your payments are processed on the last business day of the billing cycle for the upcoming month. There will be a charge of $25 for any NSF cheques. Notice of discontinuation is required in writing 30 days prior to the last lesson. There are no reductions in lesson fees due to missed appointments. “No shows” will not be made up. The only guaranteed make-ups are for teacher absences and studio weather cancellations. We allow for two Vacation days taken Sept through June and two during July and Aug to use at your discretion. Please notify us of these prior to billing.

I have read and agree to these terms and conditions:

Name:______________________________________Signature:__________________________

Student Information

Name _______________________________________________________________
Age (if under 18) ___ Birth date ___________________ Male/ Female __________ Address______________________________________________________________ City__________________________ Postal Code______________________________
Phone Number (home/work)______________________________________________ Email________________________________________________________________
Parent Name___________________________ Contact #_______________________ Instrument/Program________________________Experience____________________
How did you find out about Capstone Music? _________________________________ Teacher___________________________ Lesson Day _________Time____________ Occasionally photographs are taken at the studio. Please let us know if your students are not to be included in these opportunities________________________________________________ Payment Information

Credit Card #: ________________________________________________________________ expiry date: ___/___

** Card holder signature ___________________________________________ If card holder is different than student please fill in below. Name___________________________________________________________ Address__________________________________________________________ City_____________________________________________________________ Postal Code______________________________________________________ Phone # (home/work)_______________________________________________

Registration Date:___________________________________ Employee ID:_________ Reg Fee $25________Lesson Fee _______________Paid_________ QB___CAM___

14-1500 Upper Middle Road, Burlington ON L7P 3P5 905-315-8911 www.capstonemusic.ca