Music Interest and Registration – City Dance & Music

First and Last Name*

First and Last Name of person taking class

Age of Person Registering*

Child/Teen Student
Adult Student

Parent's Name*

Email*

Enter Email Confirm Email

Parent's Email*

Enter Email Confirm Email

Phone*

Parent's Phone*

Student's Birthdate*

mm/dd/yyyy

Previous Experience*

I am registering for*

Class:*

These are our most popular lessons offered. If you do not see your instrument of choice, please enter below.

Enter instrument here if not listed above

Children & Teen Availability

Monday - after 4p
Tuesday - after 4p
Wednesday - after 4p
Thursday - after 4p
Saturday - between 10a -2p
Sunday - between 12p -4p
I would like to discuss another lesson time

Check ALL that apply:

Availability

Monday
Tuesday
Wednesday
Thursday
Saturday

Check ALL that apply:

Instruction Method*

Online (Zoom, Google Meet) Only
In-person Only
Either option

Have you registered another child in your family for dance or music classes?*

Are you a returning student or a new student ready to register today?*

All families are charged an annual $35 registration fee. If you have registered any children for another dance or music class, you will not be charged again.

Price:

All new students require a consultation to discuss the goals of lessons.

Price:

Consent*

I have read and agree to the music tuition and fee policy.

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Music Registration Form

City Dance & Music

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