Pro Line Music Online Registration

Registration

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Welcome to Pro Line Music and Fitness online registration. Please provide your information below and click Submit when complete. Credit cards are NOT charged at this time.

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Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Disabilites

Allergies

Medications

Primary Doctor

Choose any filter to narrow your search

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Private Music Lesson Policy

Lessons are scheduled by the month. Advanced payment is required to reserve the day and time of your lessons. Tuition is $88 per month for a four week month and $110 for a five week month. No cancellations, make ups or refunds for missed lessons. Called in cancellations result in loss of lesson. New students may begin at any time. All payments are made online through our secure portal. If you must pay on the store we will add a processing fee of $12.

I've read the above and agree.

Private Lesson Payments

Re-enrollment payment for lessons must be made by the 21st of each month to remain on next month's schedule.
A $10 late fee will be imposed for all late payment of tuition, regardless of what date the lessons may fall upon. It is the student's responsibility to get the payment made before the 21st. Payments can be made via credit card over the phone if necessary. Sign up for automatic credit card payments is encouraged. Failure to pay by the 21st may result in the loss of your time slot. In the event of a teacher absence we will provide another qualified teacher. If this is not possible, a lesson credit will be issued. We reserve the right to substitute teachers if necessary. New students may begin at any time. Students with lessons falling on holidays when the school is closed will have $22 deducted from the month's total or get a lesson credit for next month. We will charge your card on the 1st of the month if you have not paid or responded to our emails so let us know if you are not continuing by the 21st.

I've read the above and agree.

Vacation Policy

Vacation days must be scheduled at time of payment. We limit them to 3 per year per student, $22 will be deducted for vacation days
In the event of a teacher absence we will provide another qualified teacher. If this is not possible, a lesson credit will be issued. We reserve the right to substitute teachers if necessary. New students may begin at any time. Students with lessons falling on days when the school is closed will have $22 deducted from the month's total or get a lesson credit for next month. Also $22 will be deducted for vacation days. In the event of closure due to storm or "act of god" we will offer one makeup. If you cannot make the makeup you lose the lesson.

I've read the above and agree.

Liability

Release of Liability
Parents or legal guardians of students, who are minors, and students (both minors and adults), waive the right to any legal action for any injury sustained on school property during normal lessons or any other activity engaged in by the students before, during or after the lesson time, and assume the risk of any injury. Further, such parents or legal guardians of students, who are minors, and students (both minors and adults) shall hold harmless and indemnity the Studio from any claim or damages arising from any injury.
The school is not responsible for providing class care for students before or after the lesson. Parents with students under the age of 10 must remain in the school during the lesson. If students are left at the school before or after the lesson, the parents assume the risk for the safety of the student, without limitation, during such time.
Pro Line Music reserves the right to terminate lessons to any students at the discretion of its staff.

Signature Text
I have read and understand the policies and procedures and agree to abide by them. I understand any or all of these policies and procedures could change without notice.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*