Fall 2011 Registration
Parents Names
Home Address
Where did you hear about us?
Is this your first session?
For continuing students only:
Has any of your information changed?
Which class are you registering for?
(fees include tuition & materials,
$10 registration fee added after
Aug. 15)
Do you already have materials for this class?
(If so, material costs will be taken off total)
What day & time is your first choice?
What is your second choice?
Do you have any other discounts?
Is there anything else you would like us to know?
Students Name
Birthdate
Home Phone
Cell Phone
Work Phone
Email address
Does your child have any allergies?
Does your child have any developmental delays or special needs we should be aware of?
Has your child had any prior music education?
There is a $10.00 registration fee after August 15. There is a $25.00 charge on all returned checks and a $25.00 cancellation fee. The registration fee is non-refundable. There are no cancellations/refunds after August 15. While we make every effort to provide a child safe environment, you are responsible for supervising your child while on the premises or in a class together. SCCM and it’s agents are not liable for accident or injury on or near the premises. On occasion we take photographs in class to use for educational or promotional purposes. Your registration confers consent of all aforementioned policies. Please check the box to verify that you have read and accept such policies:
Online registration is only for credit card or paypal payments. If you wish to pay by check, cash, or monthly payment plan do not use this form, contact the director at frano@pacbell.net to request a different form.
