AJ's Music Factory Online Registration

Registration

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Welcome! Please fill out this form to register for lessons at AJ's Music Factory.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Contact #1

Parent/Guardian or Adult Student First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Parent/Guardian First Name

Last Name

Type

How can we contact you?

Home Phone

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

Can your family do off-peak hours of lessons (M-Th 9AM-3PM)?*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please note: You are registering for a certain type of lesson, not the day or time. Lesson time scheduling requests will be sent out as we near the upcoming school year.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Can your family do off-peak hours of lessons (M-Th 9AM-3PM)?*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please note: You are registering for a certain type of lesson, not the day or time. Lesson time scheduling requests will be sent out as we near the upcoming school year.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Can your family do off-peak hours of lessons (M-Th 9AM-3PM)?*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please note: You are registering for a certain type of lesson, not the day or time. Lesson time scheduling requests will be sent out as we near the upcoming school year.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Can your family do off-peak hours of lessons (M-Th 9AM-3PM)?*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please note: You are registering for a certain type of lesson, not the day or time. Lesson time scheduling requests will be sent out as we near the upcoming school year.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

Can your family do off-peak hours of lessons (M-Th 9AM-3PM)?*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Please note: You are registering for a certain type of lesson, not the day or time. Lesson time scheduling requests will be sent out as we near the upcoming school year.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)