Richardson School of Music Online Registration

Student #1

Student's First Name*

Last Name*

Student Gender Identity*

Birth Date*

Cell #

Additional Info

Student Email

School (write n/a if not applicable)*

Grade Level *

Transportation (Early Release Program) Please indicate if your child requires a car or booster seat *

Disabilities (write n/a if not applicable)*

Special Needs (do you or your child have any special needs we/our instructors should be aware of)*

Allergies (Required field for Day/Summer Program Students. Other students may write n/a)*

Medications (Required field for Day/Summer Program Students. Other students may write n/a)

Primary Doctor and Number (Required field for Day/Summer Program Students. Others may write n/a)

(Required field for Day/Summer Program Students. Other students may write n/a)*

Photo/Video Release? (Y/N)*

Please click on the "Select Class" button below to view our available lesson times. If your desired class/time is not offered below, please contact the office to assist you. It is Optional to enroll in a class. Please Note: Students must contact the office to confirm a lesson/group class time. Enrolling in a class via our calendar below DOES NOT CONFIRM YOUR START DATE. New students will receive a Welcome E-mail from our office to confirm your class/lesson day and time.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender Identity*

Birth Date*

Cell #

Additional Info

Student Email

School (write n/a if not applicable)*

Grade Level *

Transportation (Early Release Program) Please indicate if your child requires a car or booster seat *

Disabilities (write n/a if not applicable)*

Special Needs (do you or your child have any special needs we/our instructors should be aware of)*

Allergies (Required field for Day/Summer Program Students. Other students may write n/a)*

Medications (Required field for Day/Summer Program Students. Other students may write n/a)

Primary Doctor and Number (Required field for Day/Summer Program Students. Others may write n/a)

(Required field for Day/Summer Program Students. Other students may write n/a)*

Photo/Video Release? (Y/N)*

Please click on the "Select Class" button below to view our available lesson times. If your desired class/time is not offered below, please contact the office to assist you. It is Optional to enroll in a class. Please Note: Students must contact the office to confirm a lesson/group class time. Enrolling in a class via our calendar below DOES NOT CONFIRM YOUR START DATE. New students will receive a Welcome E-mail from our office to confirm your class/lesson day and time.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender Identity*

Birth Date*

Cell #

Additional Info

Student Email

School (write n/a if not applicable)*

Grade Level *

Transportation (Early Release Program) Please indicate if your child requires a car or booster seat *

Disabilities (write n/a if not applicable)*

Special Needs (do you or your child have any special needs we/our instructors should be aware of)*

Allergies (Required field for Day/Summer Program Students. Other students may write n/a)*

Medications (Required field for Day/Summer Program Students. Other students may write n/a)

Primary Doctor and Number (Required field for Day/Summer Program Students. Others may write n/a)

(Required field for Day/Summer Program Students. Other students may write n/a)*

Photo/Video Release? (Y/N)*

Please click on the "Select Class" button below to view our available lesson times. If your desired class/time is not offered below, please contact the office to assist you. It is Optional to enroll in a class. Please Note: Students must contact the office to confirm a lesson/group class time. Enrolling in a class via our calendar below DOES NOT CONFIRM YOUR START DATE. New students will receive a Welcome E-mail from our office to confirm your class/lesson day and time.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender Identity*

Birth Date*

Cell #

Additional Info

Student Email

School (write n/a if not applicable)*

Grade Level *

Transportation (Early Release Program) Please indicate if your child requires a car or booster seat *

Disabilities (write n/a if not applicable)*

Special Needs (do you or your child have any special needs we/our instructors should be aware of)*

Allergies (Required field for Day/Summer Program Students. Other students may write n/a)*

Medications (Required field for Day/Summer Program Students. Other students may write n/a)

Primary Doctor and Number (Required field for Day/Summer Program Students. Others may write n/a)

(Required field for Day/Summer Program Students. Other students may write n/a)*

Photo/Video Release? (Y/N)*

Please click on the "Select Class" button below to view our available lesson times. If your desired class/time is not offered below, please contact the office to assist you. It is Optional to enroll in a class. Please Note: Students must contact the office to confirm a lesson/group class time. Enrolling in a class via our calendar below DOES NOT CONFIRM YOUR START DATE. New students will receive a Welcome E-mail from our office to confirm your class/lesson day and time.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender Identity*

Birth Date*

Cell #

Additional Info

Student Email

School (write n/a if not applicable)*

Grade Level *

Transportation (Early Release Program) Please indicate if your child requires a car or booster seat *

Disabilities (write n/a if not applicable)*

Special Needs (do you or your child have any special needs we/our instructors should be aware of)*

Allergies (Required field for Day/Summer Program Students. Other students may write n/a)*

Medications (Required field for Day/Summer Program Students. Other students may write n/a)

Primary Doctor and Number (Required field for Day/Summer Program Students. Others may write n/a)

(Required field for Day/Summer Program Students. Other students may write n/a)*

Photo/Video Release? (Y/N)*

Please click on the "Select Class" button below to view our available lesson times. If your desired class/time is not offered below, please contact the office to assist you. It is Optional to enroll in a class. Please Note: Students must contact the office to confirm a lesson/group class time. Enrolling in a class via our calendar below DOES NOT CONFIRM YOUR START DATE. New students will receive a Welcome E-mail from our office to confirm your class/lesson day and time.

Enroll in Classes

Select Class

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

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

eCheck/Bank Draft

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

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

eCheck/Bank Draft

Required Policies

(Show-Hide Details)