45 Central Street Norwood, MA 02062 phone: (781) 201-9800 fax: (781) 762-3378

REGISTRATION FORM

STUDENT INFORMATION:

Student!s Name:________________________________________________________

Street:_________________________________Town:_______________Zip:________

Home #:_______________________________ Cell #:__________________________

Date of Birth:_________________________________ Age:______________________

School:______________________________________ Grade:____________________

Medical Issues:_________________________________________________________

PARENT INFORMATION:

Mother!s Name:_________________________________ Phone #:________________

Father!s Name:__________________________________ Phone #:________________

Emergency Contact:_____________________________________________________

Parent!s Email:_________________________________________________________

Classes will be held once a week for 1 1/2 hours. Please provide us with times you
would prefer.

What day (Mon- Sun):___________________________________________________

Day or Evening:________________________________________________________

What instrument(s) does the student play?___________________________________

How long has the student been playing this instrument?_________________________

Has the student had formal lessons?________________________________________

What style of music does the student enjoy most?_____________________________

Does the student enjoy singing?___________________________________________

List five songs (title and artist) the student would like to play (use back for more space).

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Original music is enthusiastically encouraged. Does the student write original music?

_____________________________________________________________________

Any other info that might be helpful in placing the student? _______________________

______________________________________________________________________

$105 deposit required (or tuition payment in full) at time of registration. Students will not
be placed in a band until deposit is received. Deposit is refundable with 7 days notice of
withdrawal prior to the session beginning. Deposit is non-refundable if student has been
placed in a band and does not attend. Tuition balance is due at beginning of first band
class. Withdrawal from the program after one class will result in an 80% refund.
Withdrawals must be in writing and delivered 24 hours before the second class begins.
After the second class there is no tuition refunds.

Payment option available on 14 week sessions only and as follows:

$105. deposit at registration
$105. due at first class
$105 due on week 4
$105 due on week 8