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Piano Play Music

Group Student Registration

* Required

Are you signing up an:
Online Class In Person Class
How did you hear about us?:
Family Member Friend Search Engines Referred By:
Billing Information?:
Continuing Student(s) New Student(s)
Contact Information:*
Mother Father Guardian
First Name:*
Last Name:*
Email:*
Cell Phone:
Home Phone:
Emergency Name:
Emergency Phone:*
Billing Address:
Address:*
 
City:*
State:*
Zipcode:*
Student - 1st Child:
First Name:*
Last Name:*
Allergies?:*
Yes No
Describe:
Birthday:*
Select Location:*
 
Day and Time options:
Select Class:*
Class Day:*
Child 1 (Group):
$   
Do you have a Second child?
Student - 2nd Child:
First Name:*
Last Name:*
Allergies?:*
Yes No
Describe:
Birthday:*
Select Location:*
 
Day and Time options:
Select Class:*
Class Day:*
Child 2 (Group):
$   
Group Tuition and Registration are Non Refundable
Child 1 (Group):
-
Child 2 (Group):
-
Total Amount Due:*
$   
Payment Information:
Name as it Appears on Card:*
Type of Credit Card:*
Credit Card Number:*
Card Id (CVV2/CID):*
(What is the Card ID?)
Credit Card Expiration:*
Month Year
Please read tuition policies on the back or below

I/We request Piano Play to reserve a place for my child/children for the terms of this contract. I acknowledge that Group Class Tuition is NON-REFUNDABLE. Refunds will be given only if the group class is cancelled of there is no group teacher available to student’s schedule time. I have read, understood and agree to this Registration Form. Please initial here.


I accept terms and conditions above