test form BAMS New Student Registration Your Teacher(s)* Mr. Hays, guitar Mr. Ciampoli, violin Mr. Winter, piano Mr. Rocheteau, percussion Mr. Streckfus, guitar Mr. Baker, low brass Ms. Antonenko, voice and piano Dr. Park, piano Ms. Hague, piano Ms. M. Katsu, flute Ms. Celozzi, piano Mr. Jenkins, piano Dr. Dillon, piano Mr. Khodyko, violin and viola Ms. Timko, voice Ms. Biskup, piano Student InformationAre student(s) under 18 years of age?*YesNoAre you enrolling more than one student?*YesNoStudent Name* First Last Date of birth* MM DD YYYY Lesson Length*30 Min45 Min60 MinDate of first official lesson* MM DD YYYY 2nd Student Name First Last Date of birth (2nd student) MM DD YYYY Lesson Length, 2nd Student30 Min45 Min60 MinDate of first official lesson, 2nd Student MM DD YYYY 3rd Student Name First Last Date of birth (3rd student) MM DD YYYY Lesson Length, 3rd Student30 Min45 Min60 MinDate of first official lesson, 3rd Student MM DD YYYY Parent/Guardian name(s)FirstLast Party responsible for payment.* First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home Phone*Cell/Text*Work Phone*for emergenciesPayment InformationPayment Plan*BudgetSemesterI prefer to pay using:*Credit CardPayPalCheckCashI prefer to pay using:*Payment is due before the start of the semester.CheckCashCredit CardPayPalMedical and Emergency All information is confidential. Please tell us about any medical, physical, or other concerns that may affect the applicant’s participation in BAMS programs. List any allergies and medications being taken and give the name and phone number of up to three emergency contacts in preferred calling order. Attach additional information if necessary. Allergies/Meds: Additional Emergency ContactsNamePhone Summary of PoliciesProgram: Lessons are offered weekly on the same day and time each week—weekly attendance and daily practicing is expected. A studio recital takes place each semester; participation is strongly recommended but not mandatory. For more information on our philosophy and program benefits, please see our website at www.belairmusicstudios.com. Refunds: With written notice of a student’s intent to terminate private lessons, pro-rated tuition from the start of the upcoming month will be refunded minus 25% of the original tuition. The refund will be based on the date the written notice is received. This applies only to the Semester Payment Plan. Notice for discontinuing the Budget plan must be given a month in advance; there are no refunds for the Budget plan, and students are obligated to pay for lessons four weeks from the date when notice is received. Budget plan: There are 48 lessons on our academic calendar. That is an average of 4 lessons per month. We bill you for 4 lessons each month, whether there are 5 or 3 lessons scheduled in that month. That is because we know that after a year, you will have received all of the lessons that you paid for. Therefore, if you tell us in advance of a planned absence (using the monthly schedule notification form), and that planned absence is on a day we are open according to our calendar, we will subtract the cost of that lesson from your bill. As we are closed during Christmas break and Easter break, those dates are not included in the 48 total lessons in our academic year. Missed Lesson Policy: If a student must miss a lesson, they should contact their teacher. For this reason, contact information should be exchanged at the first lesson. Lessons can be made up under two conditions: if the conflict is a recognized religious or civic holiday, AND they have given at least 48 hours notice. Other lessons missed by the student are generally forfeit, except in case of illness or other events beyond the student’s control. For more information, please consult the Bel Air Music Studios Payment and Attendance Policy, which can be viewed at http://belairmusicstudios.com/bel-air-music-studios-payment-and-attendance-policy/, or in the drop-down at the bottom of this form. Withdrawal Policy: Semester plan: With written notice of a student’s intent to terminate private lessons, pro-rated tuition from the start of the upcoming month will be refunded minus 25% of the original, total tuition. The refund will be based on the date the written notice is received. Budget plan: Notice for discontinuing the Budget plan must be given a month in advance. There are no refunds for the Budget plan, and students are obligated to pay for lessons four weeks from the date when notice is received. Bel Air Music Studios waives all responsibility for injuries sustained by students, parents, or guardians on the premises. Web Site Opt-in/out*BAMS has my permission to use my image (or child's image if parent or guardian) or recital video to be featured on the Bel Air Music Studio's website.BAMS does not have my permission to use my image (or child's image if parent or guardian) or recital video to be featured on the Bel Air Music Studio's website.Policy AgreementDeclaration: I have read and understand the payment options and procedures of Bel Air Music Studios. I understand the two payment options, and the due dates for payment. I will endeavor to give notice of absences by the 21st of each month for the following month (budget plan), and realize that if I do not, I will be billed for four (4) lessons that month. If I choose the semester plan, I will endeavor to attend all lessons. I have read and understand the attendance policies and make-up procedures of Bel Air Music Studios. I understand that a lesson must be excused in order to obtain a make-up lesson, and the definition of an excused absence. I will accept a substitute instructor in the rare event that the regular instructor is absent. If I wish to be excused for a holiday, I will submit a form either by the 21st of the month for the following month, or, if I choose the semester plan, at the beginning of the semester. I recognize that there are no refunds on the budget plan, and limited refunds on the semester plan. I understand that withdrawal requests must be in writing to the director, and that I will be required to pay for lessons one month after the request is received. Name*Parent/guardian if student is under 18. First Last Today's Date* MM DD YYYY PhoneThis field is for validation purposes and should be left unchanged.