Private Lesson Contract – Non-Miss Maria’s Student

This contract must be filled out in its entirety and brought to the office before private lessons begin. The availability of private lessons is limited and is taken on a first come first serve basis. Therefore, if you wish to discontinue a private lesson, you must give the instructor a 2 week notice. Private lessons must be paid for on a monthly or weekly basis, depending on whichever the instructor prefers.
Cost for private lessons
Half hour private lesson - $30
Half hour semi-private lesson (2 students) - $24 per student
Half hour trio-private lesson (3 students) - $20 per student
Please note: Non-Miss Maria's students must pay a studio fee of $4 per lesson paid directly to Miss Maria's.

Student Name*
First Last
Age*
Please enter a number from 4 to 18.
Date of Birth*
MM slash DD slash YYYY
Parent Name*
First Last
Phone*
Email*
Type of Private Lesson*
What type of Private Lesson will you be doing? Jazz, ballet, tumbling, etc.?
Preferred Instructor*
If you have already contacted an instructor, please let us know who. If you would like for us to contact an instructor, please let us know who all you had in mind.
Preferred Dates/Times/Length*
Let us know when, what time, and how long you would like to do private lessons. If you have already selected a time with an instructor, please write down what days/times you are meeting.
Hold Harmless Agreement*
The undersigned, in consideration of participation in this program, agrees to indemnify, defend, hold harmless and release Miss Maria’s Dance, Cheer & Gymnastics, Inc., its officers, directors, instructors, employees and/or assigns, from any and all direct or indirect liabilities, injuries and/or death, costs, damages and reasonable attorneys’ fees, which may be suffered by the below named individual registered in this program arising out of or in any way connected with participation in the program including parties and special events.
- I agree
Facility Use Fee*
- I would like to pay 1 lesson at a time ($4)
- I would like to pay 4 lessons at a time ($16)
Total
$0.00
Credit Card

American Express
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MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address*
Street Address Address Line 2 City State ZIP Code

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