KPS MUZIC
REGISTRATION FORM
Registration Fee: $50 (one time payment)
MONTHLY FEE: $160 (4 classes. Classes are approx. 1 hour per week)
Payable by:
CashApp: $keyshamonet
PayPal or Zelle: musicvessel.love@gmail
Venmo: @Keysha-Taylor
Student's Name:_________________________________D.O.B________Age_________ Sex:_____
Name of School:___________________________________________________Grade:____________
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Student’sName: ___________________________________D.O.B_______Age:_______ Sex: _____
Name of School:___________________________________________________Grade:____________
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Student’sName: ___________________________________D.O.B_______Age:_______ Sex:______
Name of School:___________________________________________________Grade:____________
Any of the above Student(s) had previous piano training (If yes, please describe): ____________________________________________________________________________________
Parents/Guardian Information:
Parents Name/Legal Guardian: _________________________________Cell #:________________
Address:__________________________________________________________
______________________________ City: _______________________________
State: ____________Zip Code: ___________________
E-mail________________________________________
Email________________________________________
Person Responsible for Payment:
Name:________________________________________________Relationship:____________________
Employment:______________________________________ Work #__________________________
Alternate person to contact in case of emergency:
Name:_______________________________________________Phone#__________________________
Address:_____________________________________City_________________________Zip__________
CONSENT WAIVER:
I, _________________________________the undersigned (parent or guardian of Student, if a minor) grant authority to Keysha’s Piano Studio (KPS) to render a judgment concerning medical assistance in the event of illness or an accident. Permission is given to KPS for treatment to
Student deemed necessary by staff or emergency personnel. In addition, it is hereby agreed that in a case of emergency KPS may have emergency personnel administer any emergency treatment necessary to Student.*I represent and warrant that I have read, agree to and understand all the policies set forth above, on KPS website(s),social media accounts, in the enrollment agreement, and any other policies provided by KPS (“KPS Policies”). I understand that all Students must comply with the KPS Policies. I understand that KPS reserves the right to dismiss Students from our program who are not abiding by the KPS Policies. If you are under the age of 18, you must review KPS’s Policies with your parent and/or guardian to confirm that you and your parent and/or guardian understand and agree to KPS’s policies. By signing this document, you hereby represent and warrant that you are more than 18 years of age, or an emancipated minor, or possess legal parental and/or guardian consent, and are fully able
and competent to enter into KPS’s Policies, and to abide by and comply with KPS’s policies.
____________________________________________________________Date___/___/____
Signature of Parent/Guardian of Minor or Signature of Student
KPS ENROLLMENT AGREEMENT FORM
The student(s) listed above (hereinafter “Student”) and the undersigned (parent or guardian of Student, if a minor) agrees to have Keysha’s Piano Studio (hereinafter “KPS”) teach the
Student in classes of the arts, during the next 12 months under the terms and
conditions hereinafter set forth:
1. Registration Fee: $50
2. Monthly Tuition Rates:
a. 0ne Class per week - $160 month (per person)
(For each sibling, take $10 off of monthly rate. For example,*1st child is $160, 2nd sibling - $150, 3rd sibling - $140)
____1. Monthly Tuition: KPS Tuition is due on the 21st OF EVERY MONTH. The undersigned promises to pay the above stated tuition to KPS on the 21st of each month and to comply with the terms of this paragraph. If Monthly Tuition is not paid by CashApp, PayPal, Venmo, or Zelle
or credit card online to KPS on or before the END of a month, then the Monthly Tuition will be considered late and will be automatically charged to the credit card listed in this agreement on the 1st of the subsequent month. If this credit card is declined or there is no credit card on file, then a late fee of $50.00 will be added to the Monthly Tuition. Students who have not timely paid their Monthly Tuition to KPS will not be allowed to attend classes, rehearsals, or recitals. Upon non-payment of two consecutive months of lessons, lessons will be terminated without further notice. KPS will assess a credit card payment fee per transaction. Non-Sufficient Funds (“NSF”) transactions will be assessed as a $45 bank charge. Credit card notification disputes will be assessed at $50 per transaction dispute.
______2. Photo/Video:
The undersigned hereby grants permission to KPS, its owner, operator, agent, related companies and/or assignees, to use Student’s name, image, voice, likeness, and photograph for any purpose, commercial, advertising, or otherwise, in any media or distribution method, including without limitation, on KPS website(s) and/or any other social media, for no financial remuneration.
Further, the undersigned understands that KPS, its owner, operator, agent, related companies and/or assignees, will not be held liable for any injuries and/or damages not caused by or resulting from the negligence of KPS, its owner, operator, agent, related companies and/or assignees, which may occur due to the use of the Student’s name, image, voice,
likeness and photograph.
______3. Liability:
The undersigned understands and agrees that KPS is not a talent agency or a booking agency and that Student is taking classes at his/her own sole risk and agrees to hold KPS, its owner, operator, agent, related companies and/or assignees, harmless for any liability, claims or demands for personal injuries, sickness, or death as well as expenses due to loss or damage to personal property while on or off the premises. Further, the undersigned understands and agrees that KPS will not be held liable for any injuries and/or damages not caused by or resulting from the negligence of KPS, its owner, operator, agent, and/or assignees, on or off the
premises.
______4. Attendance: PLEASE BE ON TIME! Each class begins with warm-ups which
are essential to student technique. To not be a distraction, students arriving after warm-ups (10-15 minutes late) may be asked to observe class and not participate. During recital period, there will be no make-up classes. The time and dates for classes will be set at KPS’s
sole discretion and will be posted on the KPS’s website, Facebook, Instagram and/or other social media accounts. Students are required to check the KPS’s website, Facebook, Instagram and other social media accounts for updates, curriculum, and other information. Students must arrive 15 minutes prior to class. The curtain will close after the first 10 minutes of class. A Student who arrives 10 minutes late to class must report to the front desk and will be
considered tardy for that class. An issuance of a second tardy to a student will
count as an absence and the student will not be permitted to attend classes for
that date.
______5. Proration: KPS monthly tuition is calculated on a yearly basis subdivided into monthly installments. KPS does not charge more for months with five lessons nor extra rehearsals. Therefore, if your child(s) participate in KPS annual recital the month of June will Not be prorated, regardless of executing KPS 30-Day Withdrawal Form. Withdrawal will take effect in July. It is further understood that it is the undersigned’s obligation to make payments regardless of whether the student attends classes. There are no refunds, exchanged for
classes. KPS reserves the right to cancel lessons that fall on holidays, national holidays, hurricanes, or any other event.
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KEYSHA’S PIANO STUDIO. ENROLLMENT AGREEMENT FORM
______6. Attire: Wear comfortable
clothing
______7. Rehearsals for Recital: Rehearsals will be provided by KPS free of charge. However, if Student misses three (3) rehearsals during the term of this Agreement, the undersigned agrees to pay $18 per rehearsal. The time and dates for rehearsals will be set at KPS’s sole discretion and will be posted on the KPS website, Facebook, Instagram and/or other social media accounts. Students are required to check the KPS ’s website, Facebook, Instagram and other social
media accounts for updates, curriculum, and other information.
______8.
Class Books: All books will be purchased through the owner KPS. Excludes extra notebook, pencils, erasers.
______9. Temporary Account Freeze Notice: Freezing is a temporary hold on your account and class, not a cancellation. Freeze Forms must be submitted by the 28th day of the current month to freeze the following month. For example, a freeze form submitted on March 18th will freeze the April payment, but one submitted on March 29th will freeze the May payment. A charge of $13.00 per month is made for freezers. You may freeze for up to 2 consecutive months at a time. Freeze is limited to twice a year. Freeze accounts must be on auto draft with a valid credit card on file. Accounts and enrollments will automatically recommence on the pre-determined freeze end date above. At the end of the account freeze term, your monthly tuition will continue with your next scheduled auto draft date and all freeze fees paid will be credited at 100% to your account.
______10. Thirty Day Notice:
This contract for classes can be cancelled with 30 days’ written notice, and this agreement will be hereby terminated with a signed withdrawal form. Without a signed and dated withdrawal form, all payment for the year must be paid monthly, as stated in paragraph 1 above.
______11. Late Fee: A $50 LATE FEE WILL BE ASSESSED FOR TUITION AS SET FORTH IN PARAGRAPH 1 ABOVE. I UNDERSTAND MY RIGHTS AS STATED ABOVE. All prices are subject to change. ANY AND ALL PAYMENTS AND/OR FEES ARE NON-REFUNDABLE &/or NON-EXCHANGEABLE/NO CHARGEBACKS.
______12. Adding or Dropping a Class: In the interest of keeping tuition accounts up-to-date and accurate, a Student who wishes to drop a class from which they are registered MUST
sign the “Class Withdrawal” form 30 days prior to the termination date, or the undersigned will be responsible for FULL tuition payments. Until a Student is officially withdrawn, KPS will consider the Student to be an active Student in our program. Coming into the studio and signing the withdraw form is the only way to withdraw from a class.
______13. Insurance: KPS does not carry medical insurance for its Students. It is required that all Students be covered by their own insurance policies and if an injury occurs it is understood that the Parent’s/Student’s own policy is the only source of reimbursement. KPS will not pay nor
reimburse any nor all medical expenses incurred.
______14. Annual Registration: Is $30 per family per calendar year. Once the new year commences in January Registration is due again in the amount of $30 for that year till December.
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KEYSHA’S PIANO STUDIO. ENROLLMENT AGREEMENT FORM
______16. Governing Authority: This Agreement shall be construed and enforced
in accordance with the laws of the State of Florida. The undersigned consents to the exclusive
jurisdiction of the Circuit Court of Broward County or the United States District
Court for the Southern District of Florida. The prevailing party in any action for either damages or injunctive relief shall be entitled to an award of attorneys’ fees and costs incurred in at all pre-litigation, post-litigation, trial and appellate phases. If you are under the age of 18,
you must review all the policies set forth in this enrollment agreement, the KPS Registration Form, KPS’s website(s), social media accounts, and any other polices provided by KPS (“KPS Policies”) with your parent and/or guardian to confirm that you and your parent and/or
guardian understand and agree to KPS’s policies. By signing this agreement, you
hereby represent and warrant that you are more than 18 years of age, or an emancipated minor, or possess legal parental and/or guardian consent, and are fully able and competent to enter into KPS’s Policies, and to abide by and comply with KPS’s policies.
_____________________________________________________________________________
Student Name Signature of Parent/Guardian of Minor
or Signature of Student
________________________________________________
Student Name
________________________________________________________________________________________
Student Name Date
