from the Piano Studio of   Judith Moslak...              

6933 Pebble Park Circle    West Bloomfield, MI 48322   (248)626-8982        www.Judy

   Registration Form for Piano Lessons 2015-2016

I have read and understand the Policy Sheet for 2015-2016. 

Please note: Monthly tuition is payable in advance at your first lesson of each month/4 weeks. 

          No refunds or extra make-ups will be given for cancelled lessons. Parents may          

arrange to trade lesson times if a conflict arises. Please notify Ms. Moslak of the change in advance.

Signed:______________________________________________________Date________________, 2011.


Please reserve a lesson time for ____________________________________________________.


For new students:

Length of lesson preferred:

_____ 30-minute private lesson weekly @ $570.00 per semester or $120.00 per month.

_____ 45-minute private lesson weekly @ $855.00 per semester or $180.00 per month.

Current students who are re-registering may follow last year’s payment schedule.

To reserve your time slot, please enclose the following in an envelope:

1. Your completed “Times Available” sheet.

2. This Registration Form

3. Student Info Sheet.

4. Video and Photographic Release Form (at the end of the Policy Sheet).

5.. Check (made out to Judith Moslak) which includes:

Tuition for first semester (or first month if you prefer)          $_____

Book Deposit(includes $15.00 non-refundable Materials Fee)65.00

Federation Festival Solo Event (add $20.00)_____

MMTA Application Fee (add $32.00)_____

Misc. owed:_____

TOTAL ENCLOSED          $_____


             Mail check with Registration forms to the address above.

                Current students will be given preference provided 

                                         check and Registration/Availability Forms

                                               are received by August 15, 2015.

              You will receive an e-mail stating your lesson time.

                     Lessons begin Tuesday, September 7, 2015.