Student's Name:

Age:   Adult Infant 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Birth Date:

Parents or Guardians Names:

Address:

City: State: WA OR Zip:

Home Phone: Work : Cell:

Email Address:

Siblings Names: Age:   Adult Infant 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age:   Adult Infant 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Any Special Needs?

How did you find out about us?

-------------------------------------- Class Selection ----------------------------------------

All private and semi-private lessons are monthly from September to mid-June.

Materials fee may apply and will be due the first lesson.

Piano Keyboard:

Private Piano Lessons  - Select Length: 30 minute 45 minute 60 minute
Semi-Private Piano Lessons - Select Length: 30 minute 45 minute 60 minute

Guitar:

Private Guitar Lessons  - Select Length: 30 minute 45 minute 60 minute
Semi-Private Guitar Lessons  - Select Length: 30 minute 45 minute 60 minute

Private Bass Guitar Lessons  - Select Length: 30 minute 45 minute 60 minute
Semi-Private Bass Guitar Lessons  - Select Length: 30 minute 45 minute 60 minute

Strings:

Private Violin Lessons  - Select Length: 30 minute 45 minute 60 minute
Semi-Private Violin Lessons  - Select Length: 30 minute 45 minute 60 minute

Private Viola Lessons  - Select Length: 30 minute 45 minute 60 minute
Semi-Private Viola Lessons  - Select Length: 30 minute 45 minute 60 minute

Voice:

Private Voice Lessons - Select Length: 30 minute 45 minute 60 minute
Semi-Private Voice Lessons - Select Length: 30 minute 45 minute 60 minute

------------------------------------- Day/Time Selection ------------------------------------

Please select two day/time combinations that will work for you.

1st Choice Day: Time:

2nd Choice Day: Time:

------------------------------------- Payment Options ---------------------------------------

Materials and first month's tuition must be paid at registration. Your space in class will be held for 5 days to allow time for receiving your payment. If payment is not received by the end of 5 days or by the first class (whichever is sooner), your space in the class will be opened up to next registrant.

I agree to abide by the policies of Musical Beginnings. I am enrolling myself or my child in Private or Semi-Private Lessons. I understand there is a 2 month minimum enrollment. A 30 day notice must be given along with a completed and signed withdrawal form in order to stop charges.

I also understand that I am responsible for supervising my child(ren) while on the premises of Musical Beginnings studio. Musical Beginnings is not liable for any injury on or near the premises.

Occassionally Musical Beginnings takes photos of students within classes to use in education or promotion of the studio. If I do not wish for my child(ren) to be photographed, I will let the instructor know the first day of class.