Music Registration

STUDENT INFORMATION

Student Name: *
Current Age: *
Birthdate: *
 / 
 / 
T-Shirt Size:*
School:

PARENT/GUARDIAN INFORMATION

Parent/Guadian Name:*
E-mail:*
Cell Phone:*
-
Mailing Address:*
I UNDERSTAND MY ACCOUNT WILL AUTOMATICALLY BE BILLED ON THE FIRST OF EACH MONTH. BILLING AMOUNT IS NOT PRORATED DUE TO SCHEDULED HOLIDAY CLOSINGS.*
I UNDERSTAND MY ACCOUNT WILL BE BILLED A ONE TIME REGISTRATION FEE OF $50.*
I UNDERSTAND A 30 DAY NOTICE TO THE OFFICE (NOT INSTRUCTOR) IS REQUIRED FOR WITHDRAWAL OF AUTOMATIC MONTHLY BILLING.*
I UNDERSTAND MISSED CLASSES DUE TO ABSENCE OF STUDENT ARE NOT CREDITED OR MADE UP UNLESS CLASS HAS TO BE CANCELLED DUE TO ABSENCE OF INSTRUCTOR. CLASSES CANCELLED DUE TO INCLEMENT WEATHER ARE NOT CREDITED OR MADE UP.*

Music Classes
Private classes for Piano, Violin, Viola, Cello, Clarinet, Trumpet, Saxophone, Guitar, Ukulele, and Voice 

Please select the classes you wish to attend:


Private Music Lessons are:
$100/month for 30 minutes weekly
$150/month for 45 minutes weekly
$190/month for 60 minutes weekly

Pick length of private lesson*
Register for Private Violin
Register for Private Viola
Register for Private Cello
Register for Private Piano
Register for Private Guitar
Register for Private Ukulele
Register for Private Voice
Register for Private Clarinet
Register for Private Saxophone

BILLING INFORMATION

You can pay with a credit card or debit card. Payments will be withdrawn automatically on the first of each month.

Payment of Method:*
Name on Credit Card:*
Billing Address if different from your mailing address:
Card Card Provider:
Debit/Credit Card Number (no dashes):*
Card Security Code (3 numbers on back):*
Expiration Month on Card:*
Expiration Year on Card:*

ADDITIONAL INFORMATION

If you feel there is any additional information that we need to be aware of or comments you wish to add to your registration, please enter it below.

Additional Information or Comments you would like to provide:

SEND US YOUR REGISTRATION

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