Private Lesson Student Scholarship Registration | Pacific Crest Youth Arts Organization

Student Information
Student Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Age*
Gender
Ethnic Category
For analysis purposes only.
Phone*
Email*
Enter Email Confirm Email
Address*
Street Address City State ZIP Code
School*
If not in school, please enter None
Parent Information
Parent/Guardian Name
First Last
Phone
Email
Enter Email Confirm Email
Lesson Information
Lessons*
Pacific Crest will match you with one of our private instructors; however, if you wish to request a specific instructor, you may enter their name in the next field. We will do our best to accommodate you.
Instructor Requested (optional)
Lesson Type*
Private Lesson Terms
Schedule*
I/We agree
Lessons must run on schedule in order to not interrupt the flow of other lessons scheduled with the same teacher.
Missed Lessons*
I/We agree
Missed lessons may be made up at another time, but no refunds will be granted.
Instructor Assignment*
I/We Agree
Pacific Crest reserves the right to reassign a private music lesson student to a different instructor if necessary.
Cancelled Lessons*
I/We Agree
If the lesson cannot start on time, it will not be cancelled for a period of up to the first 10 minutes. If the lesson does not commence within the first 10 minutes, all parties agree to treat the tardy as a missed lesson and agree to arrange a make-up lesson.
Student Signature*

Enter full name.
Parent Signature*

Enter full name.
Signature*
I/We Accept
I/We understand that checking this box constitutes a legal signature confirming that I/we acknowledge and agree to the above terms of the Pacific Crest Private Lessons Program.
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RegistrationID*
Name
This field is for validation purposes and should be left unchanged.

Student Information

Parent Information

Lesson Information

Private Lesson Terms