Northside School of Music Online Registration

Registration

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Welcome to Northside School of Music! Please complete the following registration form.
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Programming is billed monthly on the first of the month. You may select whichever tier best fits you. If you choose your own rate, please enter your monthly rate in the comment box .
Group classes are discounted by 11.75%

We ask for demographic information to ensure that we are serving our community equitably and fairly. If you do not wish to disclose, please enter

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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*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Preferred language

Military or veteran status?

Contact #1

Contact #1 First Name*

Last Name *

Type*

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

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Cell #

Additional Info

Student Email

School

Grade Level*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Ethnicity *

Preferred Pronouns*

Instrument to learn*

Scholarship Y/N?*

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*

Birth Date*

Cell #

Additional Info

Student Email

School

Grade Level*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Ethnicity *

Preferred Pronouns*

Instrument to learn*

Scholarship Y/N?*

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*

Birth Date*

Cell #

Additional Info

Student Email

School

Grade Level*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Ethnicity *

Preferred Pronouns*

Instrument to learn*

Scholarship Y/N?*

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*

Birth Date*

Cell #

Additional Info

Student Email

School

Grade Level*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Ethnicity *

Preferred Pronouns*

Instrument to learn*

Scholarship Y/N?*

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*

Birth Date*

Cell #

Additional Info

Student Email

School

Grade Level*

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Ethnicity *

Preferred Pronouns*

Instrument to learn*

Scholarship Y/N?*

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

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Account Information

Membership Type*

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)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

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