Piano Central Studios Online Registration

Registration

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Welcome to Piano Central Studios! To register, complete your information below and click SUBMIT when finished. Please note that credit cards are NOT charged at this time. All enrollments are considered pending until we have reviewed and confirmed your registration. We look forward to having you in our program and a part of our PCS family!

* 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*

Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Work #

Cell # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level*

Name of CCES classroom teacher?

Special Needs (Leave blank if NONE)

Enrolling for what instrument?

Any previous experience?

Already have your instrument?

List any scheduling requests

Preferred start date?

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level*

Name of CCES classroom teacher?

Special Needs (Leave blank if NONE)

Enrolling for what instrument?

Any previous experience?

Already have your instrument?

List any scheduling requests

Preferred start date?

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level*

Name of CCES classroom teacher?

Special Needs (Leave blank if NONE)

Enrolling for what instrument?

Any previous experience?

Already have your instrument?

List any scheduling requests

Preferred start date?

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level*

Name of CCES classroom teacher?

Special Needs (Leave blank if NONE)

Enrolling for what instrument?

Any previous experience?

Already have your instrument?

List any scheduling requests

Preferred start date?

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level*

Name of CCES classroom teacher?

Special Needs (Leave blank if NONE)

Enrolling for what instrument?

Any previous experience?

Already have your instrument?

List any scheduling requests

Preferred start date?

Choose any filter to begin viewing available classes.

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)