Registration Form




Student’s Name:_______________________________________________


         Age:______School Grade________Date of Birth________________


Home Telephone Number________________________________________


Home Address_________________________________________________


Mother’s Name___________________Cell Phone____________________


Father’s Name____________________Cell Phone____________________


EMAIL ADDRESS_______________________________________________


                  Lesson Day____________Time_______________




1.  Payments must be made according to the monthly payment schedule.  The teacher is not obligated to give lessons for which no payment has been made, or to make up lessons which were missed when payments were in arrears.


2.  Notification of inability to attend a lesson is a courtesy to the teacher, but the teacher cannot excuse payment for lessons which are missed.  There will be no make-up lessons for student absences.


3.  Lessons canceled by the teacher will be rescheduled at t mutually agreeable time.  Refunds will be made if this is impossible.  A student absent for a make-up is responsible for payment.


4.  Contracting for private lessons obligates a student for a minimum of three months.  The initial three months for a new student is a probationary period, after which a consultation between the student, teacher and parent will be held to discuss and review the student’s progress.  If either party wishes, an instructional change may be made at that time.


5.  At the teacher’s discretion, certain lessons, either partially or in full, may be used for parent consultation.


6.  There is a $20 fee (in addition to the bank fee) for all returned checks.


The signer understands the payment  schedule and agrees to, and understands the policies stated above.


Signature of Parent or Guardian________________________________________date_______




Contact Me:

Terri Henningson
(404) 271-3177

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For information of Ms. Henningson's art, please go to

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INSTA:  @terrihenningsonart


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