Registration Form 2021-2022 Parent Name:*FirstLast Address:* Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Student Name (1):*FirstLast Instrument Choice(1):*SelectPianoVoiceViolinGuitarDrums Student Name (2):FirstLast Instrument Choice(2):SelectPianoVoiceViolinGuitarDrums Phone:* 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 lessons Birth-date (1):*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Birth-date (2):01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901yearOn 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 Class Private Lessons:30 min. Private Lessons45 min. Private Lessons60 min. Private Lessons Preferred Day:*MondayTuesdayWednesdayThursdayFridaySaturday Preferred 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:*VisaMastercardDiscover Credit /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