Registration
**This class meets on Tuesdays from
10-10:30am EST
and Wednesdays from
3-3:30pm EST
starting September 8th 2020. Students may take one or both classes each week, but both classes cover the same material.**
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
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
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Instrument:
*
Lesson Length (45 or 60 min):
*
Preferred Lesson Day:
*
Additional questions/comments?:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Instrument:
*
Lesson Length (45 or 60 min):
*
Preferred Lesson Day:
*
Additional questions/comments?:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Instrument:
*
Lesson Length (45 or 60 min):
*
Preferred Lesson Day:
*
Additional questions/comments?:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Instrument:
*
Lesson Length (45 or 60 min):
*
Preferred Lesson Day:
*
Additional questions/comments?:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Instrument:
*
Lesson Length (45 or 60 min):
*
Preferred Lesson Day:
*
Additional questions/comments?:
Additional Information:
Class Policies
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1) There is a $25 monthly subscription fee for this class. This includes access to both weekly classes as well as class recordings.
2) Billing takes place on the 5th day of each month for that month.
3) Xylophones and rhythm sticks are encouraged but not required. Please let us know prior to purchasing as we will send a list of recommended products.
4) Recordings of each class will also be made available if students need to miss a class.
5) Both weekly classes cover the same material, and students are encouraged to take at least one class per week, and may take both classes for added reinforcement of material.
6) All classes will be conducted via Zoom, and passwords will be sent out prior to the first class. Students should download the free Zoom app prior to their first class, but a unique account is not needed.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Address Line 1:
Address Line 2:
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
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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