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 while completing these forms, call/text 203-283-8003.

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-long lessons are $380 per month. There is a one time registration fee of $35.00 per student, or $60.00 per family.

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 absences, 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. You may also request a pre-recorded video lesson for your absence. This will be recorded and sent to you. You do not need to give 24-hour notice to receive a make-up class or pre-recorded video.

Make-up classes will be cancelled if no one signs up at least 48 hours in advance. The teacher scheduled to teach the class may be different due to unforeseen circumstances such as illness or bad weather.

If the teacher is absent, Purple Deer Music Academy will attempt to provide a substitute teacher. Since all teachers teach a little differently, it is beneficial for music students to have a substitute teacher from time to time. If a substitute is unavailable, a private make-up lesson will be scheduled within two weeks. If you cancel the lesson with the substitute teacher, you may sign up for one of our group make-ups or request a pre-recorded video lesson from the substitute teacher.

Lessons may be moved online at your usual time for student or teacher illness. Lessons may also be moved online due to inclement weather such as snow. Online lessons are regular lessons and are equal in private instruction to in person lessons. If you cancel the online lesson you may sign up for one of our make-up classes or request a pre-recorded video lesson from your teacher.

To report absences and sign up for make-up classes or 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's lessons. Students will be responsible for their last month's tuition whether or not they attend lessons.

AVERAGE OF FOUR LESSONS A MONTH

Monthly tuition is based on a 47-48 lesson year. We are closed for all holidays, April break, last week of June starting on Tuesday - July 4th, the last week of August starting on Tuesday- Labor Day, December holidays and one additional week. Some months you'll have three lessons, some months five lessons and most months four lessons. Tuition is the same each month as it makes accounting easier.

SUMMER VACATION

Purple Deer Music Academy operates years round. We are happy to offer our students unlimited make-up classes, pre-recorded video lessons and even the chance to lease your lesson time to a family member or friend. So if you are taking a month or so off and want to resume the when you return - at the same time with the same teacher- your tuition is still due to reserve your lesson space. Most of our students who will be away for the summer months complete their make-up lessons before they leave or some before and some after. You can even do a combination of make-up lessons and pre-recorded video lessons to hold your lesson time while you are away.

CARE OF STUDENTS

It is preferred that an adult remain on site during lessons for all students in grades Pre-K through 2nd grade. Students in grades 3-12 can be dropped off if they do not need help carrying their instrument up the staircase to our 2nd floor location.

An adult must come in to pick up students in grades Pre-K through grade 8. Please do not ask them to meet you outside. Students in Grades 9-12 may leave unaccompanied with a signed form on file.

All students will check in and check out at the front desk.

Purple Deer Music is not responsible for students who leave unaccompanied. We expect all students to be picked up on time when their lessons are finished.

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 rooms have a glass window on the doors.

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

INJURIES/ILLNESS WAIVER

Parents, legal guardians of minors and adult students waive the right to any legal action agasinst Purple Deer Music Academy of Fairfield LLC for any illness including but not limited to Covid-19, or any injury including but not limited to hearing loss or damage, contracted or sustained as a result of the student's participation in Purple Deer Music's programs. This holds true whether the student, their sibling or other family member was at our school or at any location where Purple Deer Music Academy holds events. Purple Deer Music Academy is not responsible for any 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 vehile waiver and that you agree to abide by them.

Please sign and date *

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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.

Please sign and date *

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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 *

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Name on Card *

Credit Card Type *

Credit Card Number *

Code *

Expiration Date (mm/yy) *

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

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