Stubbs Music

Registration Forms

                                           STUBBS' MUSIC CENTER, INC.
1260 Timberlane Road                   Phone: 850-893-8754
Tallahassee, FL 32312    Fax: 850-668-8507
President, Martha H. Stubbs                                                 Email: music@stubbs.org

                           2009-2010 REGISTRATION FORM
                                               Summer, Fall, Spring Semesters

STUDENT INFORMATION:


Semester(s) you are registering for:
Summer 2009  Fall 2009  Spring 2010  *Student Name: *Birthdate School: PARENT INFORMATION:
*Mother's Name: Email Address: Address: Father's Name: Address if Different: Home, Work and Cell Number: List Class time or request day(s) for scheduling: *Type of Lesson
Group
Private
Instrument or Name of Class: Previous Instruction:
Yes
No
If yes, what instrument and how long? If yes, what instrument and how long? If yes, what instrument and how long? Listed below are registration and materials fees by Semester. The lesson fees are billed separately.
All New Students:                                    Summer-$65     Fall-$65     Spring-$65
Returning Piano Students:                         Summer-$35     Fall-$55     Spring-$45
Returning Instrumental Students:               Summer-$35     Fall-$45     Spring-$35
TRANSPORTATION: (Only available during Fall and Spring Semesters)
Billed by Semester: Gilchrist $3.50 per week and all others $5.00 per week.
DURING THE DAY: Maclay (Monday-Thursday)

CONTRACTUAL AGREEMENT: I understand that lessons are taught and billed by semester. Lessons
missed by student will be made-up ONE per semester. SMC reserves the right to change lesson and theory times
within allotted time agreed for instruction without notice. I know that lesson fees are to be paid by the 10th of
each month, or I will automatically be charges a $20 late fee to my account. I know that I will automatically be
charged a $20 fee for returned checks. I know that I am responsible for any additional material fees received
during each semester. I understand that if I stop coming to lessons before the end of a semester, I am
RESPONSIBLE for the balance on my account. Lessons can ONLY be terminated at the end of a
semester with a THIRTY DAY WRITTEN NOTIFICATION; otherwise, students are
AUTOMATICALLY ENROLLED for FOLLOWING SEMESTER.

By checking this I agree that I have read and accept the Contratual Agreement;
Yes

Please make your choice of one of the five following payment options.

*Please make your choice of one of the five following options.
Pay in full, per semester, by check or credit card
Provide post-dated checks monthly, per semester with all checks submitted one week prior to the beginning of the semester
Credit Card number (Visa/Mastercard) to be run at beginning of each month
Authorized Bank Payment or Web-Pay from your account directly to SMC
Credit Card number/ expiration date I UNDERSTAND THAT MY PAYMENT OPTION CHOICE IS APPLICABLE FROM TODAY'S DATE THROUGH MAY 2009. *Responsible Party Date: