MERRY MELODY
MUSIC ACADEMY
Registration Form
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Please register for the 2022-2023 school year below. We are looking forward to make music with you!
Fall
Monday, September 12, 2022 to Tuesday, January 31, 2023
Spring
Wednesday, February 1, 2023 to Sunday, June 18, 2023
Summer
Monday, June 26, 2023 to Saturday, August 26, 2023
There is a $30 per family registration fee to register for each school year. The fee will be added to your first invoice of the school year.
For families with multiple students, you may fill out one form if lesson availability is the same.
Please write down in the Additional Notes box at the end of the form which instrument(s) is for which student(s) if there are multiple students taking different instruments on the same form.
Be sure to hit the submit button at the bottom to submit the form! Thank you so much!
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Contact Information
Parent Name*:
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Student Name*:
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Student Birth Date*:
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Student School Grade*:
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Address*:
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City*:
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State*:
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Zip Code*:
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Home Phone:
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Cell Phone*:
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Email*:
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* Required
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Invoice Delivery Method
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Instrument
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| Referral
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Preferred Lesson Format
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Lesson Availability
Please let us know about your availability during the school year by filling out the following. Please be certain of your schedule before you let us know because it's very difficult to change it after it's scheduled since it involves moving many others.
Please fill in the earliest possible start time and the latest possible end time on the days available for lessons. Please try to give more than one day and time if possible, as there are many factors in considering a schedule, especially a teacher's driving route.
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Monday:
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Tuesday:
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Wednesday:
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Thursday:
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Friday:
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Saturday:
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Sunday:
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Additional Notes
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| Credit Card Information
Please enter your credit card information below. This will be for our files only, and your card will not be charged unless you have an outstanding balance of more than 30 days. You are not signing up for recurring billing by entering this number.
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Name on Card*:
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Credit Card Number*:
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Expiration Date (mm/yy)*:
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CVV*:
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Billing Zip Code*:
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By clicking on the Submit button below, I have read, understand, and agree to the terms stated in the Studio Policies. I authorize Merry Melody Music Academy to charge my credit card above in the full amount of my balance due if I have an outstanding balance for more than 30 days.
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