Registration Form 2021-2022 ; Parent Name:* First Last Address:* Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryStudent Name (1):* First Last Instrument Choice(1):*SelectPianoVoiceViolinGuitarDrumsStudent Name (2): First Last Instrument Choice(2):SelectPianoVoiceViolinGuitarDrumsPhone:* Area Code - Phone Number E-mail:*How did you hear about us?:* Additional Notes: Please notate any additional information we should know regarding your child participating in music lessonsBirth-date (1):*01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearBirth-date (2):01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearOn this page when you select the class you are signing up for you will find the total cost of the semester has been added to your total. The Fall and Spring Semester consists of 18 lessons each and you have the option of paying for the entire semester upfront or you can divide your payment into equal monthly payments; which are due on the first of each month. Upon enrolling, you are committed to the entire semester of lessons. To withdraw you must notify the studio within 30 days. Annual Registration:*Select IndividualFamily Classes:Beginner Group PianoVocal Explorers ClassPrivate Lessons:30 min. Private Lessons45 min. Private Lessons60 min. Private LessonsPreferred Day:*MondayTuesdayWednesdayThursdayFridaySaturdayPreferred Time of Day:*2:00pm-3:00pm3:00pm-4:00pm4:00pm-5:00pm5:00pm-6:00pm6:00pm-7:00pm7:00pm-8:00pm10:00am-1:00pm (Sat)1:00pm-4:00pm (Sat)A $50 deposit is due at the time of enrollment and is non-refundable. The remaining balance is processed when you come in for your first lesson. All classes must meet required enrollment minimum. If minimum is not met, all deposit fees will be refunded.Card Type:*VisaMastercardDiscoverCredit /Debit Card Number:* Expiration Date:*Security Code (Cvv):* Total:By submitting this form:• The submitting of this form implies agreement to, and the observance of, the Studio Policy of NC Music Center, and the payment of all fees associated with the course(s), lessons, instruction, sessions as listed above.I understand my child may be photographed /video graphed for use by NC Music Center publications/website or for use by all forms of media.SubmitReset