House Of Music PSL Online Registration

Registration

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Welcome to House Of Music PSL! Please complete the following registration form.
PRIVATE LESSONS: Please type in our COMMENTS your interest for piano, guitar, drums, vocal or language classes. We will contact you for more details.
GROUP CLASSES (MUSIC EDUCATION, ARTS, DRAMA, LANGUAGE) AND CAMPS: Click on ENROLL CLASSES to choose your group class.

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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 *

How Can We Contact You?

Home Phone

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Put N/A if none)*

Diagnosis (Put N/A if none)*

Allergies (Put N/A if none)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Put N/A if none)*

Diagnosis (Put N/A if none)*

Allergies (Put N/A if none)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Put N/A if none)*

Diagnosis (Put N/A if none)*

Allergies (Put N/A if none)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Put N/A if none)*

Diagnosis (Put N/A if none)*

Allergies (Put N/A if none)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Put N/A if none)*

Diagnosis (Put N/A if none)*

Allergies (Put N/A if none)*

Please click on the Search button below, then choose the class.

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*

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Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

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)

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Questions or Concerns

Payment Information

Credit Card

Required Policies

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