New School Of Music Registration Form

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New School of Music Registration Form
Student’s Name:
Date of Birth (if under 18) ____/____/____ School:
2nd Student’s Name:
Date of Birth (if under 18) ____/____/____ School:
For students under 18: Parent/Guardian Name:
**If student is under 18, please use contact information of the parent/guardian for the information below.**
Mailing Address:
City
State
Zip
Home Phone:
Cell:
Work :
Email
2nd Parent/Guardian Name:
Mailing Address:
City
State
Zip
Home Phone:
Cell:
Work :
Email
Student 1, Term you are registering for:
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● Private Lessons:
Fall 2014
Spring 2015
2014/2015 School Year
Summer 2015
Teacher Name:
Instrument/Voice:
□
□
□
Length of Lesson:
30
45
60 minutes
Number of lessons: _____ Day & Time of Lesson
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● Group, Ensemble or Vacation Class:
Fall 2014
Spring 2015
2014/2015 School Year
Summer 2015
Class Name
Class Day & Time:
● Workshop/Masterclass: list class date
Student 2, Term you are registering for:
□
□
□
□
● Private Lessons:
Fall 2014
Spring 2015
2014/2015 School Year
Summer 2015
Teacher Name:
Instrument/Voice:
□
□
□
Length of Lesson:
30
45
60 minutes
Number of lessons: _____ Day & Time of Lesson
□
□
□
□
● Group, Ensemble or Vacation Class:
Fall 2014
Spring 2015
2014/2015 School Year
Summer 2015
Class Name
Class Day & Time:
● Workshop/Master class, include workshop name & date
□
□
□
□
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How did you hear about us?
From a current student/friend
Print Ad
Flyer
Direct Mailing
Other
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Please check here that you have reviewed the policies and procedures of NSM.
Payment:
$
_Total Tuition
$
_Registration Fee, per term: $15/private students, $10/group classes; $20 for families
$
_I/We would like to make a donation to the New School of Music, a 501(c) 3 organization
$
_Total Enclosed
___Enclosed is my check made payable to the New School of Music
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___ Please charge my card
Visa
Mastercard
Discover
Name on Card:
Acct #:
______Exp. Date: ___/___ Signature:

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