Please Complete and either:

1. Fax to: (704) 625-3745 or

2. Mail to: 4811 Trey View Court
Charlotte, NC 28227

STUDENT REGISTRATION (Please complete one form per student.)

Student: _______________________________________________________ Nickname: _________________________________

Address: ____________________________________________________________________________________________________

School Name: ________________________________________________________ Grade: _________ DOB: ___/___/___

Parent(s) Name(s): ____________________________________________________________________________________________

Parent(s) Cell(s): _________________________________ Email: __________________________________________________

Other Information (ie: allergies, etc.): ____________________________________________________________________________

How did you hear about Charlotte Academy of Music? _____________________________________________________________

*Non-Refundable Registration Fee of $30/Individual or $45/Family is due annually at time of registration.

Payable by Electronic Debit, Personal Check or Credit Card (Visa/MasterCard only).

PHOTO / VIDEO RELEASE PERMISSION

Charlotte Academy of Music will never identify students by full name. Please indicate your approval below:
_____ I GIVE permission to use my child's photograph(s) and/or video(s) for the Academy's promotional materials.

CLASS SIGN-UP INFORMATION

A CTIVITY I NSTRUMENT L ESSON T IME (I N M INUTES )

PRIVATE LESSON ‰ 45 ‰ 60
GROUP LESSON ‰ 45 ‰ 60
ADULT STUDENT LESSONS ‰ 30 ‰ 45 ‰ 60
PIANO ARTISTRY PROGRAM ‰ 45 ‰ 60
ACADEMY CHILDREN'S CHOIR ‰ 60
CHAMBER ENSEMBLE ‰ 60

AVAILABILITY: (Please mark all that apply.)

TUITION PAYMENT OPTIONS
‰ Monday ‰ Tuesday ‰ Wednesday
‰ Thursday ‰ Friday ‰ Saturday Semester (1 Installment)
‰ Morning (8am - 12pm) ‰ Afternoon (12pm - 3pm) Quarterly (2 Installments)
‰ Late Afternoon (3pm - 5pm) ‰ Evening (5pm - 9pm) Monthly (5 Installments- *Electronic Debit Only*)

Special Considerations: PAYMENT METHOD

ELECTRONIC DEBIT from Checking Acct. (PLEASE ATTACH VOIDED CHECK)

Registration Only Registration & Tuition/Materials Tuition/Materials Only

PERSONAL CHECK (PAYABLE TO: Charlotte Academy of Music)

Registration Only Registration & Tuition/Materials Tuition/Materials Only

CREDIT CARD (Additional 3% Processing Fee / Visa or MasterCard Only)

Registration Only Registration & Tuition/Materials Tuition/Materials Only

____________________________________ _____________
Card Number Exp. Date
CLASS OFFERINGS
Private Monday Tuesday Wednesday Thursday Friday Saturday
Piano Available Available Available Available Available Available
Guitar Available Available Available Available Available
Voice Available Available Available Available Available
Brass Available Available Available
Woodwinds Available Available Available
Strings Inquire for more information.

Group Monday Tuesday Wednesday Thursday Friday Saturday

Piano Available Available Available FULL Available
Guitar Available Available Available Available Available

Other Monday Tuesday Wednesday Thursday Friday Saturday

Children's Choir 6:00 PM 5:00 PM
10:00:00 AM &
Chamber Ensemble 10:00 AM
4:00 PM

ACADEMIC CALENDAR (40 Total Lessons)

Month Month Monday Tuesday Wednesday Thursday Friday Saturday
Fall September LABOR DAY 2 3 4 5 6
Semester 8 9 10 11 12 13
15 16 17 18 19 20
22 23 24 25 26 27
29 30 1 2 3 4
October 6 7 8 9 10 11
13 14 15 16 17 18
20 21 22 23 24 25
27 28 29 30 31 1
November 3 4 5 6 7 8
10 11 12 13 14 15
17 18 19 20 21 22
24 THANKSGIVING BREAK- ACADEMY CLOSED
December 1 2 3 4 5 6
8 9 10 11 12 13
15 16 17 18 19 20
22 CHRISTMAS BREAK - ACADEMY CLOSED
January 5 6 7 8 9 10
12 13 14 15 16 17
19 20 21 22 23 24
26 27 28 29 30 31
Spring February 2 3 4 5 6 7
Semester 9 10 11 12 13 14
16 17 18 19 20 21
23 24 25 26 27 28
March 2 3 4 5 6 7
9 10 11 12 13 14
16 17 18 19 20 21
23 24 25 26 27 28
30 31 1 2 3 4
April SPRING BREAK- STUDIO CLOSED
13 14 15 16 17 18
20 21 22 23 24 25
27 28 29 30 1 2
May 4 5 6 7 8 9
11 12 13 14 15 16
18 19 20 21 22 23
MEMORIAL DAY 26 27 28 29 30
June 1 2 3 4 5 6
4 Lessons to be scheduled between June 15 - August.
Summer
(Academy will be closed on July 3rd and 4th.)

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TUITION
Fall / Spring Semesters (20 Lessons Each)

Semester Tuition
Program Class Length Monthly Quarterly Semester
(5 Installments) (2 Installments) (1 Installment)
45 Minutes (includes Music Lab) $ 120 $ 300 $ 600
Private Lessons
60 Minutes (includes Music Lab) $ 180 $ 450 $ 900
45 Minutes (includes Music Lab) $ 80 $ 200 $ 400
Group Lessons
60 Minutes (includes Music Lab) $ 100 $ 250 $ 500
30 Minutes $ 100 $ 250 $ 500
Adult Student Lessons 45 Minutes $ 150 $ 375 $ 750
60 Minutes $ 200 $ 500 $ 1,000
45 Minutes $ 180 $ 450 $ 900
Piano Artistry Program
60 Minutes $ 240 $ 600 $ 1,200
Academy Children's Choir 60 Minutes $ 48 $ 120 $ 240
Chamber Ensemble 60 Minutes $ 48 $ 120 $ 240

Discounts
- Families registering for three or more lessons will receive 5% off tuition for the third and additional lessons.
- The tuition for Chamber Ensemble is discounted for students also enrolled in another program:
Monthly- $32, Quarterly- $80 and Semester- $160

Fees
The annual Registration Fee of $30 per student or $45 per family is non-refundable and is due at the time of registration. In
addition, a Materials Deposit of $40 per student will be collected at the time of registration. This deposit will be used to pay for
materials to be used in conjunction with the registered activity. Replenishments in $40 increments will be invoiced throughout the
academic year as the balance falls below $5.00. Any unused deposit at the end of the academic year will be applied to the next
academic year unless a refund is formally requested in writing.

Payments
There are three payment options to choose from- Monthly, Quarterly or Semester. The payment option selected on the registration
form for the Fall Semester will be used for the Spring Semester unless a formal notification of the change in payment option is
given to the Front Desk in writing prior to the start of the Spring Semester.

Payment methods are electronic debit from checking account, personal check or credit card. Electronic debits will occur on the 1st
of the month for each applicable month based on the payment option selected. ONLY the electronic debit from checking account
payment method is accepted for the monthly payment option. A $25.00 NSF fee will be assessed for any returned check or
declined electronic funds. All payments are due within 10 days. All invoices will be issued via email. A $10.00 late fee per week
will be assessed for any payments not received by the due date.

GENERAL POLICIES

Registration
The Academy is pleased to add new students whenever space is available. In order to be accepted into the Academy, please fill out
the Student Registration Form. A choice of schedule will not be reserved and the student will not be able to start lessons until the
completed Registration Form, Registration Fee and Materials Deposit are received. Please note that all lessons are filled on a first
come, first serve basis. Once registration is received, the Director will be in contact to discuss student/teacher placement and lesson
day/time options.

Withdrawal / Refund
Tuition refunds will be given in accordance with the following schedule. Formal notification of withdrawal must be given to the
Front Desk in writing. Registration Fees are non-refundable and any unused portion of the Materials Deposit is refundable. Full
refunds, including registration fees, will be given in cases of insufficient enrollment that results in cancellation of a class or
workshop. Partial tuition refunds will be considered in cases of prolonged illness or injury.

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 Withdrawal within ten (10) days of first lesson of the semester FULL tuition refund
Withdrawal prior to the fourth scheduled lesson of the semester 2/3 tuition refund
Withdrawal prior to the eighth scheduled lesson of the semester 1/3 tuition refund
Withdrawal on or after ninth scheduled lesson of the semester No refund

Student Supervision
All children under the age of 12 must be accompanied by a responsible adult while inside the Academy, except during their lesson
time. For children over the age of 12, a responsible adult must drop-off and pick-up the student in a timely manner. Charlotte
Academy of Music is not responsible for the student before or after their assigned lesson time.

Student Absence / Make-Up Lessons

Students taking private lessons are allowed one (1) make-up lesson per semester (two (2) during the course of the academic year)
for student cancellations. All make-up lessons must be scheduled through the Front Desk. There are no make-up classes for the
Academy Children's Choir, Chamber Ensemble or group lessons. All lessons (including the Academy Children's Choir, Chamber
Ensemble and group lessons), classes or workshops cancelled because of teacher absence or school closing will be made up.

Practice
The teacher will make the student and parent aware of specific practice expectations. Each practice session should be free of
household distractions.

Lesson Protocol
The teacher will pick-up the student from the reception area and escort them to their lesson. Parents are welcomed to remain in the
reception area during the student's lesson. The teacher will escort the student to the reception area at the conclusion of the lesson. If
a student is tardy, their lesson will not be extended past their originally scheduled lesson time.

Food / Drink
No food or drink (except bottled water) is allowed in the Academy.

School Closing / Inclement Weather

In the case of inclement weather, the Director will make a decision whether the Academy will be open. A message will be recorded
on the Academy’s voicemail and a notice will be posted on the Academy's website.

ACKNOWLEDGMENT

I certify that the information above is complete and correct. In addition, I understand and agree to the policies and guidelines above
and accept responsibility for any charges and fees that may be incurred.

____________________________________________________________ __________________________________
Signature of Student (or Parent / Guardian if Minor) Date