New Student Registration

Student name *

Age and Date of Birth *

Instrument *

Additional student name

Age and Date of Birth

Instrument

Address *

City *

State/Province *

Zip/Postal Code *

Parent or Guardian *

Phone *

Email Address *

Emergency contact *

Emergency contact phone number *

Best days/times for lessons - please give 2-3 choices *

Best times to call you should we need to speak with you *

Please tell us who can pick up your child from lessons *

Please tell us if there is anyone who should NEVER pick up your child from lessons -if not please type - No *

Who referred you to Purple Deer Music Academy? *

Policies and Procedures

Please carefully read our policies and procedures as we abide by them in all cases. If you have any questions please ask us.

TUITION

All payments are automatically processed by credit or debit cards during the last few days of the month for lessons to be taken the following month. Weekly half-hour lessons are $190 per month, 45-minute lessons are $285 per month and hour lessons are $380 per month. There is a registration fee of $35 per student or $60 per family which is added to the first month's tuition.

Lesson rates are subject to change with prior notice.

Tuition is never prorated for missed lessons. Tuition does not include any retail teaching materials such as music, method books or instruments.

CANCELLATIONS AND MAKE-UP LESSONS

For student cancellations, Purple Deer Music Academy holds one-hour group make-up classes every week. Each class makes up two half-hour lessons. Make-ups never expire and the dates will be sent to you when needed. With some advance notice, you may also request a pre-recorded video lesson for your absence and that video will be sent to your email. All students who miss a lesson may attend a make-up class. Make-up classes must be signed up for at least 48 hours in advance.

We do not schedule private make-up lessons for student absences. If another student is absent around the time you miss, we would be happy to let you take your lesson in that time slot. However, in the event that the other student shows up, they will receive their lesson that day.

If the teacher is absent, Purple Deer Music Academy will attempt to provide a subsititute teacher. Since all teachers are a little different, it is beneficial for music students to have a guest teacher from time to time. If a substitute is unavailable, a private make-up lesson will be scheduled within two weeks. If you do not want the lesson with the substitute teacher, you may sign up for one of the group make-up classes instead.

Lessons may be moved virtually at your usual lesson time for student or teacher illness and will be done virtually for inclement weather such as snow. Virtual lessons are regular lessons and are equal in private instruction to in-person lessons. If you do not wish to have the virtual lesson, you may sign up for one of our group make-up classes or request a pre-recorded video lesson instead.

To report absences and sign up for make-up classes or to request a pre-recorded video lesson, contact the office- NOT the instructor.

COMMUNICATION

To ensure you have the best experience, all communication is done through our office. To protect your privacy and safety, we do not share your personal information with our instructors. If you need to contact your teacher between lessons, call or text the office.

DISCONTINUING LESSONS

Past your first month of lessons, to discontinue lessons, a withdrawal form is due by the 15th of your final month to prevent charges the following month. We do not prorate tuition for the last month of lessons. Students will be responsible for their last month's tuition whether or not they attend lessons. Please note that all students who are performing in any recital or events must be currently enrolled students at the time of the recital or event.

AVERAGE OF FOUR LESSONS A MONTH

Some months you'll have three lessons, some months, five lessons and most months four lessons. Tuition is the same each month - we don't charge less for three or more for five. This makes accounting easier. You can see when the school is closed on the calendar on our website PurpleDeerMusicAcademy.com. Also in Upcoming Dates and Events in our newsletter we list when we are closed.

SUMMER VACATION

Purple Deer Music Academy operates year round. We are happy to offer our students unlimited make-up classes, pre-recorded video lessons and even the oppportunity to lease your lesson time to a family member or friend. So if you will be missing a month or so of lessons due to vacations or other activities, and want to resume right where you left off when you return - at the same time with the same teacher - your tuition is still due to reserve your lesson space. Most students who will be away for the summer months complete their make-up classes before they leave. You are also welcome to do a combination of make-up classes, pre-recorded videos and leasing your time.

CARE OF STUDENTS

All students must check in at the front desk upon arrival. After checking in, if the teacher is not ready for you yet, please wait in the waiting room. If the teacher does not come to get you and it's more than 5 minutes past the start of your lesson, let the front desk know. We make every effort to run on time but occasionally things happen.

Parents must come inside for pick up unless the student is in grades 9-12 and has a waiver on file to leave unaccompanied. When the lesson is finished, you must check out at the front desk before leaving. We expect all students to be picked up on time.

We have an open door policy and parents are always welcome to quietly sit in on their child's lesson or watch from outside the room. All doors have a window on them.

We use video and audio surveillance at our school for everyone's safety.

INJURIES AND ILLNESS WAIVER

Parents, legal guardians of minors and adult students waive the right to any legal action against Purple Deer Music Academy of Fairfield LLC for any illness, or any injury including but not limited to hearing loss or damage, contracted or sustained as a result of the students participation in Purple Deer Music's programs. This holds true, whether the student, their sibling or other family member was at our school or any location where Purple Deer Music Academy holds events. Purple Deer Music Academy is not responsible for damage done to vehicles or any items stolen from vehicles at our school or events.

AGREEMENT TO TERMS

Your signature below indicates that you have read the sections above and understand Purple Deer Music Academy's policies and procedures, illness, injury and vehicle waiver and that you agree to abide by them.

Signature that you have read and agree to abide by our policies and procedures *

clear

Image and Audio/Video Recording Waiver

At Purple Deer Music Academy, we take pictures of our students at our events and recitals. We may also record video-audio at our recitals.

Purple Deer Music Academy will never identify a minor child by name without the prior written consent of both parents. Most of what we use on social media are group pictures without names. You will always be able to opt out if we request to use a solo picture or video of your child. No solo picture of your child will ever be used without your written permission and your child will never be named when in a group photo.

Your child cannot participate in our recitals, small groups, music friends or any of our programs without this waiver. So, if you would like your child to participate please sign below. If you do not want your child to participiate, please write NO in the signature box.

By signing below you are consenting to and authorizing Purple Deer Music Academy to capture and use video-audio recordings and photographic images of the students named on this form such during our events such as but not limited to recitals. Purple Deer Music Academy may publish them in written, electronic or online media for educational and promotional purposes only, with prior written permission if naming a student and without further compensation to you. You further agree to waive and release any and all further claims against Purple Deer Music Academy relating to the use of these recordings and images. This consent is binding upon all heirs and future legal representatives.

Signature for image/video waiver *

clear

Authorization Agreement for Credit/Debit Cards

Payments are recurring and are deducted the last week of each month for lessons to be taken the following month until a withdrawal form is submitted to the Academy. Withdrawal forms are due by the 15th of your final month to prevent charges the following month.

(I/We) do hereby authorize PURPLE DEER MUSIC ACADEMY OF FAIRFIELD LLC, hereinafter named the COMPANY, to initiate recurring (credit or debit) entries to (my/our) (credit card account) as indicated and named below as the depository financial institutions, hereinafter named FINANCIAL INSTITUTION. If any such debit(s) should be returned NSF, (I/we) authorize the COMPANY to collect a returned debit NSF fee of $25.00 per item from the card idenitifed below and authorize all of the above as evidenced by my signature below.

This authorization is to remain in full force and effect until the COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford the COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it. This means submitting a withdrawal form by the 15th of my last month of lessons.

Tuition will not be prorated for the last month's lessons. Students will be responsible for their last month's tuition whether or not they attend lessons. Students can sign up for make-up classes or receive pre-recorded video lessons if they cannot attend their last month.

No refunds are given for students missing their last month. No exceptions will be made for moving, relocating, illness, etc.

Your signature below indicates that you have read the above payment authorization and agree to abide by it. After signing, please enter your credit or debit card information.

Signature of card holder and date *

clear

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Code *

Billing zip code *

Permission for Students in Grades 9-12 to Leave the Building Unaccompanied

If your child is in Grade 9-12 and you would like to give them permission to check out and leave our building unaccompanied after their lesson, please sign this form.

This form gives your Grade 9-12 child permission to leave our building on their own after their lesson. This means that you are permitting them to sign out and leave without us having to see you at lesson dismissal. Purple Deer Music Academy of Fairfield is not responsible for students who leave unaccompanied. By signing below, you understand and accept the potential risks of allowing your child to leave by themselves and you waive the right to anty legal action against Purple Deer Music Academy that may occur as a result of your child leaving the building unaccompanied after their lesson. You may change your decision at any time by submitting an e-mail or written request.

Please sign and date

clear