Please complete this registration form to apply for the Community Music School.

Submitting this online registration form does not guarantee a place in the class or in private instruction. We will confirm your registration either in writing or by telephone. Upon this confirmation, a one-time $15 registration fee is required for each family. This fee is non-refundable and is not applied to class tuition.

All items are required.

	Which program do you want to register for?		MusicPlay Piano Lab Private Lessons String Prep Suzuki Violin Music Theory
	If private lessons, which instrument or, if MusicPlay, 5:00 or 6:00 on Tuesdays?
	Your Name
	Child's Name
	Child's Gender		Male    Female
	Child's Birthdate
	E-mail Address
	Street Address
	City
	State
	Zip
	Daytime Phone
	Evening Phone

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