Form of student information and policy agreement

Sayuri Piano Academy

Student Name: _____________________________________________________

Parents: ___________________________________________________________

Home address: _____________________________________________________

Home phone: _______________________; Mobile: _______________________

Email address: _____________________________________________________

Lesson Time: ______________________________________________________

Tuition:  ___ 30-minutes ($85 per month)

             ___ 45-minutes ($125 per month)

             ___ 60-minutes ($160 per month)

Piano Lesson Agreement

I have received and carefully read through Sayuri Piano Academy's Studio Policy. I will be responsible to the annual registration fee and monthly payment. I will obey the studio policy for the late fee, missed lesson, cancellation notice and my responsibilities to my child. I would like my child to take piano lessons from SPA and understand the terms of this agreement.

Please print and sign

________________________________        ________________________________

Parent Name (please print)                                 Parent Signature

________________________________        ________________________________

Student Name (please print)                                 Student Signature

______________

Date