Suzuki Violin Lesson Registration

The Eugene Suzuki Music Academy registration form is available for download (Registration pdf). Please either fill out our online form below, or send the form to:

Eugene Suzuki Music Academy
1637 Oak St.
Eugene, OR 97401

Before sending your registration, please read the studio policy.

* = required

* Student Name

* Parent/Guardian Names

* Email

* Mailing Address

* City

* Zip Code

* Home Phone

Cell Phone

Work Phone

Choose One:

OR


Monthly tuition is paid at the beginning of the month

* Payment Type
 Cash/Check Credit Card

Paperless
 I would like my future transactions and confirmations to be paperless - Please email me important information.

Send me ESMA emails and announcements.

* Policy
 I have read, understand and agree to the Eugene Suzuki Music Academy's Studio Policy

Permission

 I give my permission for photographs and videos taken of my children and/or members of my family, to be shown or used in educational and promotional material used in connection with Eugene Suzuki Music Academy.

Scheduling
 I would like to keep my current lesson time. I would like to keep my current time, but may have some flexibility. I need a new lesson time. Here are 3 days and times that would work for me (please list different times):
Day 1 Time 1
Day 2 Time 2
Day 3 Time 3

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