Registration
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Join us as we practice singing old favorites both individually and as part of a group. This one-day workshop will focus on personal delivery as well as group blend through musical standards.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
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NJ
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NY
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OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
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WV
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Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Questions/Options:
Please give brief description of student's performance experience (school, community, church, etc.)
*
Please share any information about the student that will be helpful for the teacher to know (special needs, diagnoses, allergies, etc.)
Additional Information:
Photo Consent
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I give photo and video consent to Kelly's Music Corner, LLC. for student's likeness to potentially be used on social media and for marketing purposes.
I've read the above and agree.
Payment
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I understand payment must be made at the time of registration.
I've read the above and agree.
Payment Conditions
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I understand my payment is non-refundable. Should student be unable to attend the workshop, the payment will be held as credit towards a future KMC class/lessons/etc.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
*
Add Credit Card
eCheck/Bank Draft:
Bank Name:
Bank Routing Number:
(9-digit number)
Your Account Name:
(Your name on your bank statement)
Your Account Type:
Checking
Savings
Account Number:
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