Notable Beginnings - Music School

Individual Music Lesson Registration
Please fill out all fields as completely as possible. Thank you!

Student Information

(* = required field)

First * :

Last * :

Student Name:

Nickname (if different) :

Date of Birth *:

Instrument *:

Lesson Duration *:

Experience Level:

Current Grade:

School:

School Music Teacher:

So that we can best meet each student's individual needs, please tell us about any health or learning concerns:

First Name

Last Name

Parent/Guardian Name(s) *:

Contact Email Address *:

Day Phone:

Evening Phone:

Cell Phone:

Street Address*:

City *:

State *:

Zip *:

How did you hear about us? *:

If a current student referred you, what is their name?

Tuition Payment

Please choose one of the following convenient payment options:

Automatic monthly payment from my checking / savings account: [Help]
Name on Account :	Account Number :	Bank Routing Number :

Payment in advance for 20 lessons by credit or debit card ($440 for 30-minute lessons or $880 for 60-minute lessons, plus $30 registration fee each school year), due prior to the first lesson.
Payment in advance for 20 lessons by check or cash ($440 for 30-minute lessons or $880 for 60-minute lessons, plus $30 registration fee each school year), due prior to the first lesson.
$22 for one no-obligation 30-minute trial lesson (new students only) by cash, check or charge before the first lesson

By checking this box, I am indicating that I have read, understand and agree to abide by all policies set forth in the Student Policies & Information. I understand that failure to abide by these policies may result in dismissal from the school.