Student’s Name_______________________________ Age _____        School Grade ______      B-day_________
Mom _______________________________________
best # to reach mom _____________________________
Dad ________________________________________
best # to reach dad ______________________________
Alternative phone number ________________________ this is my   (circle one)   home      cell      work
Address ______________________________________ City ____________________ Zip _________________
Email address (please print clearly) ____________________________________________

PLEASE REVIEW SSP SCHOOL AND PAYMENT POLICIES:

I understand the terms and agreement for enrolling my child/children in music lessons. 

Signed__________________________________________ Date _____________________

Fees and Tuition:
Registration Fee: $25 for the first child and $15 for each additional
Group Zither Class: $100 per month
Private Lessons: $85 per month
Advanced Jazz Ensemble: $75 per month
Beginning Blues Ensemble: $75 per month
Drop-In Classes: $5 each

Classes enrolled:

1)_________________________ $_____ 3) _________________________ $_____

2)_________________________ $_____ 4) _________________________ $_____


Total Due: $___________ Paid $_____________ ck #_______ Cash_______