Hope Academy of Music and the Arts

2017 Summer Lesson Acknowledgement Form

Hope Academy provides space for our teaching artists and their current students who would like to continue taking lessons over the summer.(Tuesdays-Saturdays) beginning June 13, 2017.

Because administrative staff may or may not be in the building when lessons are happening, everyone must agree to a higher level of personal responsibility. Additionally, there is a major renovation project underway so we will need to know who is going to be here in order to communicate important information about access to and from rooms.

By filling out this form you are acknowledging that you understand and agree to the policies and procedures put in place for summer lessons at Hope Academy.

Student Name * First Last
Parent/Guardian Name * First Last
Parent/Guardian Email *
Parent/Guardian Phone Number #1 * ### - ### - ####
The best number to reach you. Probably a cell phone number.
Parent/Guardian Phone Number #2 ### - ### - ####
Student Phone Number ### - ### - ####
If applicable. Some teens like to receive text reminders from their teaching artists about lessons.
Student Email

If your child would like to be on the email list with updates and reminders.
Teaching Artist *
Kathleen Andrews (violin, viola) Ben Barson (sax, clarinet) Laura Carmichael (piano) Emma Cox (guitar, ukulele) Ana Diaz (cello) Beth Goldstein (cello) Ryan McMasters (bass, guitar, percussion) Jeremy Mikush (voice) Patricia Pavlack (piano) Gizel Rodriguez (voice) Kristine Rominski (flute, piano) Helga Scheibert (piano)
ACKNOWLEDGEMENT OF POLICIES AND PROCEDURES
I agree to escort my child to and from lessons and to remain in the room or adjacent hallway during lessons. *
YES NO
I understand Hope Academy/East Liberty Presbyterian Church staff will not be present during lessons and I absolve them of any responsibility for the safety of my child. *
YES NO

This is why a parent or guardian must be present to, from and during lessons.
I agree to communicate with my teaching artist -
directly and in advance - about scheduling, cancellations and delays. *
YES NO

Hope Academy's administrative staff and East Liberty Presbyterian Church's front desk staff will not take or give messages for students or teachers during the summer.
I agree to pay the teaching artist $15/half hour at the time of the lesson. *
YES NO
I understand that I am required to pay for lessons that I cancel for any reason. *
YES NO
Questions or comments
THANK YOU!
Do Not Fill This Out

Hope Academy of Music and the Arts

ACKNOWLEDGEMENT OF POLICIES AND PROCEDURES

THANK YOU!