Group Student Registration

* Required

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:
Address:*
Emergency Contact:
Phone:*
Billing 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:*
$   

Group Tuition and Fees are Non-Refundable. Group tuition and registration reserves your child’s space in the selected class(es) you have chosen as well as cover the cost of classes and materials for the semester. This fee is “Non-Refundable”. Upon receipt of your registration, a confirmation email will be sent confirming your class(es). *Sibling(s) receive 10% off of tuition, sibling discount(s) will be applied automatically on this page. If you have any questions regarding classes, please call us at (818) 789-6110 or email us at info@pianoplaymusic.com.

Payment Information:
Name as it Appears on Card:*
Type of Credit Card:*
Credit Card Number:*
Card Id (CVV2/CID):*
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