Your Full Legal Name *

First Name

Last Name

Students Full Legal Name (if not yourself)

First Name

Last Name

Acknowledgment 1 *

The student is either myself, my legal spouse, or my dependent child (under the age of 18). By checking this box, I confirm that the student is an immediate family member who qualifies for this discount.

Acknowledgment 2 *

I acknowledge that to qualify for this discount, my combined household income (before taxes) must be under $120,000 annually, and my individual income must be under $90,000 annually (before taxes). If my spouse’s income, combined with mine, exceeds these amounts, the discount will not apply. For eligibility purposes, household income includes gross income before any deductions.

Acknowledgment 3 *

The student is not benefitting from any scholarships (e.g., the Family Empowerment Scholarship or other scholarship programs)

Acknowledgment 4 *

If my situation changes and I find that the student or myself is no longer applicable to benefit from this discount I will notify the studio promptly.

Household Income Acknowledgment *

Yes or No:I have a spouse and we have a combined household income.

Yes

No

Acknowledgment 5 *

The discount will expire after six months, and reapplication is required to continue receiving the discount. We will notify you when it is time to reapply.

Acknowledgment 6

Adventures in Music reserves the right to modify, suspend, or terminate the Corporate Employee Discount program at any time, without prior notice, and such changes will apply to future lessons.