Registration Form

***Please copy and paste the below document into a word file. This form must be turned in and signed at student's first class or student will not be allowed to participate.***



Kimber Tower Sam Tower
Piano Instructor Karate Instructor
282 West 1st South Rigby Idaho
227 3200 (text or call)
ClanTower@gmail.com
www.towersteach.blogspot.com

Student Name _______________________________________________________________
Parent Name_________________________________________________________________
Type of Lesson________________________________________________________________
Home Phones_________________Cell___________________Work_____________________
Address______________________________________________________________________
Email Address_________________________________________________________________
Student Age and Experience______________________________________________________
Any other information__________________________________________________(finish on back)
***You are also required to sign the last page of the student handbook and turn it in with this registration form. Karate students are required to sign the student waiver also and turn it in before being allowed to participate in class. If you need either just ask!***
I __________________________________________ understand that I am signing to a minimum of 4 months of (circle whichever applies) Piano/Karate lessons. I understand that I am financially responsible for these 4 months and the following months after that. If I attend 1 class in a month I am responsible for payment of the entire month. If I do not attend class for 1 full calendar month and have NOT made arrangements with the instructor I understand I may not be allowed to return to classes and if I am I will have to sign another 4 month contract.

Signature or student and/or parent (if student is under 18) Date