Student's Information *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Parent/Guardian Information *

First Name

Last Name

Phone *

(###)

###

####

Parent/Guardian #2 Name

First Name

Last Name

Phone

(###)

###

####

Emergency Contact Phone Number *

(###)

###

####

Preferred Lesson Day *

Please select which days work for the student's weekly lesson.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Preferred Lesson Time *

Weekday afternoon - 2:30pm - 5:00pm

Weekday early evening - 5:00pm - 8:00pm

Saturday Morning

Saturday Afternoon

Other

Billing Policy *

By checking the box below, I am providing consent to SBSM's billing policy. I understand that I must have a valid credit card on file. My credit card will be charged on the first of every month, September - June.

I consent.

I do not wish to have my credit card on file and I will pay the entire annual tuition amount in full by 9/8/2023.

Balanced Monthly Tuition Payments *

By checking the box below, I am providing consent to SBSM's balanced monthly tuition payment plan. I understand that I will be billed a fixed monthly amount, September - June. The monthly tuition amount is 1/10th of my total tuition amount. The monthly tuition amount will remain CONSISTENT each month regardless of the number of lessons scheduled per month.

I consent.

I wish to decline the monthly payment plan and I will pay my entire annual tuition balance in full by 9/8/23.

Lesson Attendance Policy *

By checking the box below, I am providing consent to SBSM's lesson attendance policy. The objective of The South Buffalo School of Music is to offer an enriching musical and educational environment using state of the art resources and materials. In order to obtain the best results, it is imperative that attendance at all lessons be prompt and consistent. On the occasion that an instructor must miss a scheduled lesson time, the instructor is required to make up that lesson. We have embedded two weeks for make up lessons in the calendar. Teachers will be available to make up missed lessons during that week. If your instructor does not owe the student any lessons, the student does not report to a lesson during that week. Lessons missed by the student will not be made up and will not be credited. If you know in advance that you will not be able to make a lesson, you may switch lesson times with another student. Instructors are not required to make up unplanned missed lessons by the student.

I consent.

SBSM Studio Calendar *

By checking the box below, I am providing consent to adhere to SBSM's studio calendar. I understand that the calendar contains the dates of all studio closures as well as scheduled recitals and other events. Students and instructors will adhere to this calendar as the basis of their lesson schedule agreement.

I consent.

Media Release *

Media Release: Please read the following information regarding use of student photographs, videos and audio recordings on The South Buffalo School of Music Facebook page, website and printed press materials. In consideration of the opportunity of appearing in video or audio recordings, sound tracks, films, photographs, or written articles, I hereby consent to the use and editing thereof and release The South Buffalo School of Music and its employees and assignees from any and all claims resulting from such use and editing in printed media and on the Internet.

Yes, I consent to SBSM’s Media Release.

No, I do not consent to SBSM’s Media Release.