Enroll for Classes

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Student Info
Student's Name*
Student's Birthdate*
Status
Allergies/Medical Concerns
Guardian Info
Parent Name(s)*
Address*
City*
State*
Zip*
Phone*
Mobile Phone
Work/Emergency Phone
Email*
How did you learn about our program?
Class Info
Class Choice
Day/Time Preference (1st choice)
(2nd choice)
(3rd choice)
Payment Plan
Little Mozarts Year 1 or 2 $800 Academic year paid in full $80 10 monthly payments
Group Piano or Partner Piano $970 Academic year paid in full $97
Private Piano $1050 Academic year paid in full $105 10 monthly payments
Summer Enrollment $140 Summer Group Sampler $28 each Summer Private Piano Lesson
Payment Method

* = required field

Signature

I am enrolling my child at Arts & Music Center and understand that my non-refundable payment is due with registration. Furthermore, I release any and all rights and claims for damages against Arts & Music Center and its Staff in the unlikely event of injury sustained by any member of my family during the course of, or as a result of, this musical activity, before, during, or after lesson time.

In accordance with the Electronic Signatures in Global and International Commerce Act of 2000, electronic contracts and signatures are as valid as paper contracts in all states, regardless of where the parties live or where the contract is executed. You have the right to request a paper New Customer Registration sheet and Policies and Procedures sheet from us. Regardless of whether you make such a request, your electronic signature on this registration form shall remain legally valid and binding.

Parent Signature* Date*

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Music Classes

Enroll for Classes

Student Info

Guardian Info

Class Info

Payment Plan

Signature