YURICH PIANO STUDIO
Registration Form
Please complete this registration form and return it to Virginia Yurich by Septmeber 7 of each year. Only complete the top information if student is new or if there have been changes. Thank you.
Student’s Name___________________________________________________________
Address_________________________________________________________________
Home Phone_____________________________________________________________
School, Grade, & Birthdate__________________________________________________
Parents’/Guardians’ Name(s)________________________________________________
Parents’/Guardians’ Cell Phone_____________________________________________
Parents’/Guardians’ Cell Phone_____________________________________________
Parents’/Guardians’ Email Address__________________________________________
Additional Emergency Name, Relation, & Phone Number_________________________
________________________________________________________________________
Times Available for Lessons on Thursdays from October – May:
_____ 6:00 pm
_____ 6:30 pm
_____ 7:00 pm
_____ 7:30 pm
Flexible summer scheduling will be arranged for lessons from June – September (8 lessons total).
I have read “Studio Policy” and “Tuition” for the Yurich piano studio and I agree to the terms of both statements. Check: _____ YES _____ NO
Parent/Guardian Signature and Date ________________________________________
