MUSIC FOR LITTLE MOZARTS

Registration Form

General Information – Required*

Student Name*_________________________

Birthday ______________ Gender * M   F

Parent Name(s) *________________________________

Phone __________________ Other phone ______________________

Other adults authorized to drop off/pick up children – name

_________________________________, phone ___________________

Child/Parent’s home address ________________________________

_____________City_________________State_________Zip_________

e-mail _____________________

Payment Information

A one-time fee of $200  (Level 1) or $180 (Level 2) for the entire session.  A session includes: 12 classes (Level 1) or 11 classes (Level 2), the last one is a “recital” of songs learned; materials for class, awards on “recital” day.  Fee payable to Diane Quick, check or cash, before or on the first day of class.

____There is no refund for missed classes.  Teacher absence will mean an extension to the next week for make-up.

______Regular and timely attendance for all classes are expected. 

______Parents and other authorized persons are asked to not be in the studio during class.  You are welcome to observe from the windows or stay in the lower level. 

______I will not be able to do potty time or change clothes.  Please have children appropriately do their potty time before class.

Signature of Responsible Person:

          The signer understands and agrees to the registration and financial obligations as stated above and accepts responsibility for all charges.

Parent Signature: _________________________________Date:________

The instructor will contact you about specific class start dates and times.

You can send this form with a check payable to Diane Quick to hold your place in class --

or send the registration form alone and she'll contact you with more specifics!