New Customer Application Form

Name

* Please refresh page and fill out new form for each Student

Phone

Student's Name (If different than your own)

Relationship to Student

Email

Billing Address

Emergency Contact Name & Phone #

Physcian's Name & Phone # (Optional)

(optional)

Please list any physical challenges, allergies, injuries, or special needs.

If applicable.

Who are the lessons for?

Adult (Self)

Adult

Teen (Self) 13 yrs +

Teen 13 yrs +

Child

Lesson/Class Date and Time Requested

Some classes are only available at certain times. This is not a confirmation of scheduling. You will be contacted to confirm an appointment time. Our regular lesson hours are between 3pm - 8pm Mon. - Fri.

Please select the classes you're interested in:

Beginners Lessons 1/2 hr ($25.00 USD)

Beginners Lessons 1 hr ($50.00 USD)

Intermediate Lessons 1/2 hr ($55.00 USD)

Intermediate Lessons 1 hr ($55.00 USD)

Advanced Lessons 1/2 hr ($35.00 USD)

Advanced Lessons 1 hr ($60.00 USD)

Professional Lessons 1/2 hr ($40.00 USD)

Professional Lessons 1 hr ($65.00 USD)

Master Class 2 hr ($150.00 USD)

See Price Plans, Paypal Buttons & Cart to Prepay for your Lessons Online.

Select the instrument you want to learn on:

Guitar

Ukulele

Drums

Bass

Keyboard

Vocals

Mandolin

Banjo

Other

How long have you been playing?

Have you taken a music class before? What was your experience?

What about this class interests you?

What are you hoping to achieve by taking this class?

What previous experience do you have? Are you self taught, online lessons, book lessons, game lessons, in person, or otherwise?

What style & genre of music do you like?

Are you taking this class as a hobby, to play locally, or to play professionally?

What primary instrument do you play? Is it acoustic or electric?

Do you already own the required class equipment, or will you nedd to purchase an equipment package?

Learn The Beat has musical instruments & music equipment available for purchase. Please See our equipment packages to purchase your required equipment.

Have you written any songs of your own?

Have you played in a band before?

What song would you like to work on in this class?

Are you comfortable with being evaluated on skill level to place in this class & understand that you will be moved, along with your class credit, into a lower level course, if your skills don’t meet the requirements for this level class?

How did you hear about us?

Terms and Conditions

Liability: I understand that the Shannon Knox house, in which Learn the Beat is currently located, is a historical building & in some ways may not be built to current code. While Learn the Beat has made efforts to offer options for handicapped individuals to be able to participate in our services, there are certain areas of the premises that may be of safety concern to those with disabilities. Altering these areas would affect the historical significance of the building. Please ask for assistance, if you have special needs, & we will make every reasonable effort to accommodate you. This building is also a residence, I will be respectful, & mindful of that fact. I will not disturb the residence, when the business is closed. In addition please note that the stairs leading into this building & leading to the basement recording studio, & drum lesson area may not be built to modern code & could pose a hazard. By signing this liability waver you acknowledge that there may be hazards that could cause injury due to the age & build of the location, that you are entering the premises with full knowledge of this, & will take every precaution to move in a safe manner through these areas. You agree to hold Learn the Beat and its officers, directors, contractors and employees harmless against any injury, illness, theft, death, losses, damages, expenses, action, charges, causes of action, claims or demands whatsoever in law or equity which may arise from, or grow out of activities performed by the employees, officers, or contractors on behalf of, or by Learn the Beat. Parking: Please park in the spaces designated Shannon Knoxx House Parking in front of the grape vines. Parking on the side of the building is for residents only. Release Waver: Please note that Learn the Beat is located on a very busy intersection. We do not recommend you allow your child to cross the street here unattended, or that you allow them to leave the building after lessons alone to meet you at your vehicle. Please pick your children up inside of the building, after lessons. We are not a daycare, & will not insist your child stay in the building, if you leave the premises. We expect parents/guardians to remain during lessons to instruct their children on appropriate behavior. Please let us know, if you will be allowing your child to leave without an adult escort. We also do not have a public restroom. The closest public restrooms are at the Gas Station across the street & the Georgetown Park. I am responsible for any damage my child causes while at Learn the Beat & will reimburse them for the loss. Authorization to consent to Emergency Treatment: In the event of an emergency, illness, or accident: This emergency consent form, along with the medical information, verifies that the above named participant is in good health & has her/his doctor’s approval to participate in the services offered at Learn the Beat. I acknowledge that Learn the Beat, its officers & contractors, have no medical insurance coverage for me, & will not be held responsible for injuries, or illnesses that arise, while on the store premises &/or while participating in any Learn the Beat Service, or Program. In the event of an accident, injury, or illness involving the participant(s) Learn the Beat will make every attempt to notify the parent/guardian, or the emergency contact provided. If I can not be notified, I, the undersigned, or, I, the parent/guardian of a minor, hereby authorize Learn the Beat to take any steps they deem necessary to obtain medical attention. I agree to be responsible for all costs incurred as a result of the foregoing. This authorization is given pursuant to the provisions of section 25.8 of the California Civil Code. Payment & Policies: I understand that all fees for services are expected prior to time of service. I will maintain a credit of at least one lesson’s worth with Learn the Beat at all times. I understand that they are holding premium time slots for my lesson, & will loose the option to schedule another customer into the time slot, unless I call by 11:00 pm the night before to cancel a lesson for any reason. If I do not give at least this much notice of cancellation, I understand that I will forfeit the credit for that lesson. I will then need to prepay for the credit & the cost of the next lesson prior to my next scheduled lesson time. Specialty classes and VIP are not eligible for cancellation with notice credit. Slap In lessons do not require this prepayment to hold premium time slots. Learn the Beat does not give refunds. If Learn the Beat must cancel a previously paid for appointment, I will be given a credit towards my next lesson, or, if time allows, be given an option to double up on lesson time the next week to use that credit. I understand that my instructor may also need to assist retail customers that enter the store during my lesson time, if this happens, time will be added to the end of my lesson, or to my next lesson appointment. I will inform my instructor which option I prefer. During part of my lesson time I may be asked to practice on a specific skill. The instructor may leave the room, or evaluate my progress by ear, while addressing store needs, while I practice. Learn the beat does not provide instruments, or other equipment to practice on. It is not Learn the Beat’s responsibility, if I forget my lesson book, class packet, instrument, or any necessary lesson equipment for my lesson to take place. If I forget something integral to the lesson, I understand my lesson may be forfeit. I understand that most of Learn the Beat’s lesson Curriculum is based around a 1 year per level system, where the students progress at their own pace, but are expected to, on average, complete each course level in one year (Based on 1 hour individual lessons, & practice of at least 15 min. per day.). I may reach Professional Level in 4 to 5 years. I understand that Learn the Beat is not a certified school, nor are its instructors licensed/certified teachers, but I am confident in their ability to teach me using their uniquely designed teaching methods. * I agree to the above terms.

Payments Disclaimer: Walk In/Slap In Appointments – Customer does not have a reserved appointment time & pays the day of. We can not guarantee instructor availability, or class spots for these types of appointments. While we do offer this option to people strapped for time, & money, it does cause a strain on our schedule, therefore, if you do not have a credit on account to hold your appointment time you will be charged Standard Music Industry lesson rates starting at a Beginners base rate of $35 per ½ hr & $65 per 1hr Slap In Appointments. Also, if you cancel with out 24 hours notice, or have a No Call/ No Show apt. you are still responsible for paying for the appointment you missed, before we will schedule another appointment for you. If you had a credit on account, your payment for that lesson time will be forfeit, because the instructor has set aside that time out of their schedule to teach you. Each monthly payment will be charged 1 week prior to utilizing the last lesson credit on file. This allows us to reserve your appointment time. A declined transaction fee of $1.00 will be charged, each time the payment declines. For each month of non payment a Late Fee of $ 25 for under 1yr authorization packages, or $50 for over 3yr authorization packages will be charged, if the payment declines & causes your payment to be late by more than 6 days. Alternating lessons will be billed at the higher lesson level per your package selection. Payment methods accepted VISA, MasterCard & Discover. If I choose & pay for a payment package that includes monthly credit card payment authorization, I authorize Sean Carpenter, Stephanie Cimmarusti &/or independently contracted instructors of Learn the Beat to charge my credit card listed above for the amounts outlined in the selected package & on this form in the manner described. I understand that my information will be saved to file for future transactions on my account. This is a binding agreement in exchange for services & package perks based on my payment selection. I understand that, should I fail to maintain my payments as agreed, it may constitute a hardship on Learn the Beat & legal action may be taken to recover lost income. I have read, understood, & agreed to the above payment terms.

I have selected & paid for a payment plan that does not require credit card authorization.

I have selected & paid for a payment plan that requires credit card authorization & I authorize Learn The Beat to retain my information & charge my card acordingly.

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