Music Lesson Registration

Music Lesson Registration Form
Student's Name

First Name Last Name
Student's Date of Birth

Month Day Year
Date
Parent/Guardian's Name

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number (to be contacted on day of class)
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Primary Language Spoken at Home
I am registering for...
Please select from the location and duration options below:
Type of lesson student is registering for:
Student's current playing level on selected instrument (not required for general music and songwriting):
Does the student have access to the instrument they would like to learn? Students must have an instrument to play on, unless registering for voice lessons or general music and songwriting. While we do not sell instruments, we can make suggestions for cost-effective instruments upon request.

Yes No, but I will purchase an instrument prior to the student's first lesson No, I am registering for general music and songwriting or voice lessons
If you are registering for our semi-private lesson duets program, please indicate here who you will be participating with (each participant is to fill out a separate registration form):
Please select from the list below to indicate preferred days/times for scheduling purposes. We will contact you to finalize a schedule.

Virtual Lessons Tech Questions and Policies
Do you have access to a device with webcam that can connect to the internet (laptop, smartphone, computer, ipad)?

Yes No
Do you have access to an internet connection? (High speed preferred)

Yes No
Which platform do you prefer to use for your lessons?

Zoom GoogleMeet No Preference
1)Please understand that by registering for lessons, you are reserving a weekly time slot just for you that we are providing staffing for. If you do not provide 24-hour notice that you will be missing a lesson, you will be billed the full amount. If you miss more than 2 lessons in a row or more than 3 lessons in a 2-month period, we reserve the right to open up your timeslot to our waitlist. Please know, that we will discuss this with you prior to opening up the timeslot.

2)If you do not arrive on time, we will be unable to add the lost time onto the end of your session. If there are connection issues, we will do our best to make up lost time within reason.

3) No recordings or photographs will be taken or disseminated without written consent.

4) All Sing Explore Create employees are mandated reporters. We are required to report any suspicions of abuse or neglect to the relevant authorities.

Covid Guidelines

Like so many, we are excited to be even closer to "normal" life again here at SEC. Please see our most updated health and safety policies below. We appreciate your understanding that our services fall under many categories, given that we provide both recreational and therapy services for all ages. The policies below were created after thoroughly reviewing guidelines from Governor Baker's office, Department of Ed., Department of Early Education and Care, and Department of Developmental Services. We will continue to review and update our policies as necessary. Updates may be found at: https://singexplorecreate.com/covid-19-response/
Facemasks

Facemasks are required in our center for unvaccinated adult and participants and staff in our Thursday, 1-3pm Creative Arts Wellness program for adults. Facemasks are optional in our center for childre and vaccinated teens and adults (including staff). SEC staff will continue to wear a mask in private music therapy or private music lessons if requested by the student or music therapy client.

Hand Hygiene

All visitors (including staff) are required to wash their hands with soap and water or use hand sanitizer upon arrival. SEC Staff are required to wash/sanitize their hands between each group or individual session.

Screening for illness

We ask that you do not enter the center if you are sick. If you are sick or required to quarantine for any reason, please contact us to postpone your services or arrange for virtual services until it is safe for you to return to the center. If any visitor gets sick while at the center, SEC staff will guide them to a separate area away from others until they are picked up or able to safely leave on their own. Caregivers will be contacts immediately if an individual becomes sick in our center and needs to be picked up.

Cleaning

All surfaces, instruments, and other materials are cleaned between every session. Bathrooms and common areas are regularly cleaned throughout the week.

Air Quality

HEPA air filters are operating in every room and our HVAC system is updated and operating with maximum outdoor air exchange.

Use of Instruments/Materials

Group participants will be allowed to share instruments and materials. Any item that is “mouthed” or otherwise contaminated will immediately be removed from group use and fully disinfected or disposed of appropriately after the group.

Pick Up/Drop Off

Please make every effort to pick up/drop off in a timely manner. Staff need the scheduled time in between sessions to properly clean for the next student’s arrival. Please do not enter the center before your scheduled time. Frequent late pick ups may result in losing your scheduled timeslot or additional fees.
By checking below I certify that:

I have read and agree to the policies and information provided above I will adhere to all health and safety policies of Sing Explore Create, LLC (subject to change based on most current CDC and state guidelines)
Enter your name below. This will serve as your electronic signature, and indicates that you agree to the above terms and conditions. Parents/Guardians may sign on behalf of their children.
Name (Electronic Signature)

Medical Information

We collect medical information for all in-person and virtual services. The information provided would be used should we need to contact emergency services during your time with us.
Please list any allergies. Write "N/A" if none.
Do you have an epi-pen?

Yes No
Emergency Contact Name

First Name Last Name
Emergency Contact Relation to Student
Emergency Contact Phone
Please enter a valid phone number.
Medical Attention

In the event of an emergency requiring medical attention, I understand that Sing Explore Create, LLC will make every effort to contact and notify the listed parent/guardian and emergency contact listed above. However, if neither can be reached Sing Explore Create, LLC reserves the right to call emergency personnel to transport the student/client to the nearest medical facility to secure necessary medical treatment. This applies to sessions at our center, at-home visits, and online sessions.
I have read and agree to the above statement regarding medical attention.

Media Permissions

At times we may take pictures, videos, and audio recordings during classes/sessions. We utilize recorded media for marketing and professional development purposes.For marketing, recorded media may be shared to our website, professional Facebook page, and used to produce other marketing materials (brochures, newspaper articles, etc).For professional development, recorded media is NOT shared with the public. Recorded media is viewed only by staff members at Sing Explore Create for educational purposes.Please indicate your preferences below:
I give permission for Sing Explore Create, LLC to record AUDIO during classes/sessions for the following purposes:

Marketing AND Professional Development Professional Development ONLY I DECLINE permission for Sing Explore Create to record audio
I give permission for Sing Explore Create, LLC to record VIDEO during classes/sessions for the following purposes:

Marketing AND Professional Development Professional Development ONLY I DECLINE permission for Sing Explore Create to record video
I give permission for Sing Explore Create, LLC to take PICTURES during classes/sessions for the following purposes:

Marketing AND Professional Development Professional Development ONLY I DECLINE permission for Sing Explore Create to take pictures
Should be Empty:

Music Lesson Registration Form

Virtual Lessons Tech Questions and Policies

Covid Guidelines

Medical Information

Media Permissions