Name *

Agreement between Jacaranda Music Studios for weekly music instruction.

First Name

Last Name

Check all classes and/or private lessons you will be taking:

50 minute weekly Group Class: $120/month

90 minute weekly Band Sessions: $160/month

Private Lessons

30-minute weekly lessons: $160 (recommended for 4-9 year olds)

45-minute weekly lessons: $240 (recommended for 10-12 year olds)

60-minute weekly lessons: $320 (recommended for 13 + and students working towards conservatory admission)

Bi-weekly Lessons for Accelerated Learning

30-minute bi-weekly lessons: $320

45-minute bi-weekly lessons: $480

60-minute bi-weekly lessons: $640

Authorization *

I agree to purchase tuition as indicated above, based on length of lessons and number of students per the Jacaranda Music Studios price list, as an automatic charge to my credit card, or automatic debit to my checking account on the first of every month.

Billing Period

I understand that classes and private lessons are billed monthly. If I begin lessons in the middle of a billing period only the remaining lessons within the billing period will be billed to me.

Authorized Card Holder *

I hereby certify that I am the holder of the credit card, or an authorized signer on the bank checking account detailed in the account information on file.

Late Fees and Failed Authorization *

I understand that I will be notified if my credit card or checking account payment fails to authorize for any reason, and that a $20 late fee will apply if I do not provide a valid credit card or payment in full within 5 calendar days of the original rejection date.

Deactivation *

I understand that my lessons will be discontinued if my account becomes more than 10 calendar days late.

Contract Termination *

I understand that this contract may be terminated at the end of any monthly billing period. A completed request must be given in writing at least 14 days prior to my next billing date in order for the request to be effective. Note that refunds cannot be given for mid-month withdrawal from lessons.

Freezing Automatic Payments *

I understand that to temporarily freeze my auto pay, a completed request must be given in writing at least 14 days prior to my next billing date (the first of each month) in order for my request to be effective for that billing date.

Payment Method *

Self Pay

Charter Funded

Date: *

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