Lesson Registration Form

Student's Name *

Parent/Guardian's Name (if student is under 18 years of age)

Address 1 *

Address 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Any medical conditions we should know about

Student Age (if not adult)

Level

*Call in for available lesson dates & times*

717-832-6110

Date Starting Lessons

Day of the Week

Lesson Time

Instrument

Teacher

Referred by:

Lesson fees are charged to your credit card the first of each month. Notice by the last day of the month is required in order to stop lessons for the upcoming month.

Central Penn Music Lesson Guidelines

To make your lesson experience a good one, please read the following policies. We have tried to make our program as flexible and productive as possible.

Your lesson time has been reserved for you and you are paying for that time slot. Your teacher will be paid for that time whether you come or not. Please do your best to come at your regular lesson time.

Lesson billing is according to the number of lessons each month at $29 per lesson. Most months will be $116, but some months will have 5 weeks and some 3 due to holidays or teacher vacations and you will be charged accordingly. Discounts apply for multiple students in a family. 2 students will each receive a 5% discount. 3 or more students will each receive a 10% discount.

If you must miss a lesson….

At least 24 hours’ notice would be appreciated if you need to cancel a lesson, but if you give at least one hour notice, you may schedule a make-up lesson if the teacher has time available. If your teacher does not have any openings, or if the student cannot come during the teacher’s available times, that lesson will be lost. Make-up lessons are not guaranteed. If the student is stopping lessons, make-up lessons must be scheduled and completed before the date of the last lesson.
If you do not show up for a lesson and did not call to cancel, or if you call less than an hour before your lesson, there is no make-up.
If the teacher cancels a lesson or the store is closed for a day due to weather closure, a credit for that lesson will be issued for the next month of lessons. A qualified substitute teacher may be provided if your regular teacher has an extended absence.

As a courtesy to instructors at least 2 weeks’ notice is requested if you plan on stopping lessons. At the latest, we need to know you are stopping lessons by the last day of the month in order to stop billing for the upcoming month of lessons. Once the next month is billed, it cannot be reversed. A “Lesson Termination Form” must be filled out to stop the lesson billing. Speak with a salesperson at the counter in the store or go to www.centralpennmusic.com to complete this form with a CPM representative.

Please make any schedule changes through the store. It is very important that all schedule changes, billing questions, etc., are done through the store (see a salesperson or call) and we will notify the teacher of any changes.

If you have any questions or concerns regarding your lessons or lesson policies, please feel free to call or email us at sales@centralpennmusic.com

Date of 1^st lesson___________ Time___________

Teacher’s Name___________________________

Revised 9/01/2023

I have read & agree to the lesson guidelines *

Yes

Name on Card *

Credit Card Type *

Credit Card Number *

CVV *

Expiration Date (mm/yy) *

I hereby authorize Central Penn Music to charge my credit card on the 1st of the month for the number of lessons in that month. If submitted electronically your typed signature will count the some as a written signature.

Sign here *

clear

Today's Date * +

Lesson Fee