Payment/Cancelation Policy
94 State St.
New London, CT. 06320
860 443-6810 or 860 444-9677
1. Student name_____________________________________________________________
2. Parent(s) Name___________________________________________________________
3. Home Phone __________________________Cell Phone_________________________
4. Address… Home ______________________________
_______________________________
_______________________________
Email___________________________________________________
5. Medical Concerns________________________________________________________
6. Instrument_________________________ Teacher______________________________
7. I have read and understand the payment/cancelation policy
Authorized Signature: _______________________________________
8. Credit card info_________________________________________________________
9. Circle a. or b.
a. I give Caruso Music permission to video tape and photograph concert performances
of myself or child for website use.
b. I do not give Caruso Music permission to video tape and photograph concert
performances of myself or child for website use.
______________________________________________________________________________________________________________
Student Name (Please Print)
_______________________________________________________________________________ ____________________________
Signature of Parent or Legal Guardian Date
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