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 ----------------------------------------

This online registration form is for the 2009/2010 year beginning September, 2009. If you want to register for summer 2009 lessons, please call 360-882-0501.

Materials fees are included with first month's tuition. You will have an option to pay using our secured payment processor after you submit your registration.

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

Drums:

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

First month's tuition must be paid at registration and will be represented in the 'pay now' option on the next page. You will then have the option to pay in full using our secure online processor or contact us to make payment arrangements prior to the first lesson.

Material fees are due at the first lesson. Please refer to the private lesson web page to locate the material fees for the type of lesson for which you are registering.

I agree to abide by the policies of Musical Beginnings.