William Carey Suzuki Institute
This form has to be completed on-line and in upper case.
Your name:
Male:
Female:
Age:
Grade:
D.O.B :
Parent  or  Guardian:
If student is under 18
This person will be responsible for all financial matters
Address:
City:
Zip:
State:
Phones:  Home,  Work, Cell.
E-mail:
Type of lesson desired:          Violin                   Viola                       Cello                         Bass
Instructor requestt:
Every effort will be made to accommodate specific requests
Level of Instruction:         30min lesson              45min lesson               1 Hr lesson
PAYMENT CALCULATION and LEVEL SELECTION:
Annual Registration Fee: $30.-
Pre-Twinkle, Twinkle and Book 1 (Based on half-hour lesson)
Fall or Spring package: $340 (30-min private + 45-min group)
Summer lessons: $20 per 30-min lesson
Books 2 & 3 (Based on 45-min lesson) $30.-
Fall or Spring package: $450 (45-min private + 45-min group)
Summer lessons: $30 per 45-min lesson
Book 4 and above (Based on one-hour lesson)
Fall or Spring package: $590 (60-min private + 60-min group)
Summer lessons: $40 per 60-min lesson
TOTAL Ammount Due    $
All checks should be made payable to WCU Suzuki Institute
WAIVER and POLICY STATEMENT
has my permission to participate in lessons and classes through the William
Carey Suzuki Institute at the Winter School of Music on the campus of William
Carey University.

I understand that they are risks, and that my child participate in this program at
my/his own risk, and that William Carey University will not be responsible for any
personal injuries, property damage, or related expenses, including but not limited
to medical expenses, incurred as a result of my or my child's participation in this
class.

I understand and accept the policies of the William Carey Suzuki Institute as
stated in the accompanying pages, and accept responsability for charges and fees
incurred.

I will allow the William Carey Suzuki Institute to use photographs, video and
recordings made at WCU or at Suzuki functions, involving the student hereby
enrolled.

STUDENT'S SIGNATURE or PARENT / GUARDIAN SIGNATURE,
if student is under 18 years old.  If this form is sent by internet,
it needs to be signed later at the WCU's office.

NAME
Questions, comments, or feedback:
ONLINE FORM