Please review our Lesson Policy before submitting. Thank you.

Terms and Conditions: By submitting this form I understand there is a onetime $20.00 registration fee, lesson fees are payable and due to Suffield Music on the first week of each month. A $15.00 late fee will be assessed if payment is not received by the 14th day of the month. Suffield Music reserves the right to suspend lessons that are 30 days delinquent and charge any remaining balances to credit card provided with this agreement *There is a 30 day notice required to discontinue lessons. A notice of withdrawal form MUST be submitted. Lapsed attendance does not excuse a student from his/her obligation to pay.

Student First Name
Student Last Name
Instrument
Birth Date
Responsible Billing Party
Cell Phone Number
Home Phone Number
Email
Mailing Address
City/Town
State
Zip Code
*Please list any of your favorite bands/artists or styles of music interested in
*Please list preferred days and times you're available for lessons