Registration Form 2021-2022 | Music Lessons|Charlotte| Music Lesson School Piano, Voice, Violin, Drums and Guitar

Parent Name:*

First

Last

Address:*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Student Name (1):*

First

Last

Instrument Choice(1):*

Student Name (2):

First

Last

Instrument Choice(2):

Phone:*

Area Code

Phone Number

E-mail:*

How did you hear about us?:*

Additional Notes:

Birth-date (1):*

day

month

year

Birth-date (2):

day

month

year

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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:*

Credit /Debit Card Number:*

Expiration Date:*

Security Code (Cvv):*

Total:

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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.

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