AJ's Music Factory Online Registration

Registration

Already a customer? Click here to login.

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 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)