Music Preparatory School: Registration Form for Private Lessons and Classes

Summer, 2017

June 1 – August 1

Registration and payment must be completed on or before June 10.New: Payment may be submitted online by credit or debit card. Please visit our website for the link:

Forms and checks may be placed in the drop box outside room 202 in the Music Education Building or mailed to:

Dr. Carol Payne, Clayton State University, Visual and Performing Arts, Morrow, GA 30260

Student's First Name______Last Name______

Street Address______

City/zip______Age of student (or write "adult"): ______

Telephone______E-mail______

Instrument/voice______Preferred Instructor: ______

(If no preferred instructor, one will be assigned.)

Emergency Contact

Name & Phone#______

If you’d like to register for lessons with student assistant teachers, please use theMusic Preparatory School Orchestra Project, registration form.

You have the choice of signing up for either eight or five weeks of lessons. Please circle selection:

Private Lessons / Tuition per 8 Weeks / per 5 Weeks
Private Lesson: 30 min. / $176.00 / $110.00
Private Lesson: 45 min. / $264.00 / $165.00
Private Lesson: 60 min. / $352.00 / $220.00
Saturday Piano Classes
Room 147 / Four classes: June 3, 10, 17, 24 $60.00 / Four classes: July 8, 15, 22, 29 $60.00
Beginning Youth Piano Class I (ages 6 – 9) 10:00 – 10:50 am
Beginning Youth Piano Class II (ages 9 – 12) 11:00 – 11:50 am
Beginning Adult Piano Class 1:00 – 1:50 pm
Intermediate Adult Piano Class 2:00 – 2:50 pm / Lessons with Clayton State University music professors may also be arranged for additional tuition. Please contact faculty member or Dr. Carol Payne before registering.

All classes are dependent on enrollment and class size is limited. Advance registration is recommended.

Payments received after June 10 will be subject to a $25.00 late fee.Checksor Money Orders should be made payable to CSU. Payment may be submitted online by credit or debit card: Please visit our website for the link: Norefunds will be issued after lessons begin.Instructors are not required to make up lessons that students miss.

For further information, please contact:

Dr. Carol Payne, Director

678-466-5600