*Please read our updated Payments and Policies before registering. Click here to go to our Payments and Policy page.I have read and understand the Payments and Policies Yes Family Information*If you are an Adult Student, please fill out your information under Family and Student information.Parent Name (Please use your name if adult student) First Last PhoneEmail HiddenPrimaxx PhoneHidden Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Method Of Contact Email Phone How Did You Learn About The Music Connection? Internet Search Returning Student Referral Word-Of-Mouth Drive-By/Walk-In School Flyer Online Promotion Social Media Other Parent #2 (optional) First Last Parent 2 Phone Contact Number (optional)Parent 2 Email (Optional) Student InformationStudent Name First Last Please Check This Box If You Are An Adult Student Yes Student Age (not required for adult students)DOB (not required for adult students) MM slash DD slash YYYY Instrument Voice Guitar Piano Ukulele Bass Drums Sax Harmonica Clarinet Violin/Cello Rock School Music Technology Other Day (Please select only if one has been assigned)Not Assigned At This TimeSundayMondayTuesdayWednesdayThursdayFridaySaturdayTime (Please select only if one has been assigned)Not Assigned At This Time8:008:309:009:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PMInstructor (Please choose from dropdown menu)Steve PeabodyElizabeth AndersonErinn BrownRandy LeventhalDarren MuiseJohn McBreenRyan DavisonNat SimpkinsBethany VahnStudent 1 Start Date MM slash DD slash YYYY Would you like to register a second student? Yes Student 2 InformationStudent 2: Name First Last Student 2: Age (not required for adult students)Student 2: DOB (not required for adult students) MM slash DD slash YYYY Student 2: Instrument Voice Guitar Piano Bass Drums Sax Harmonica Clarinet Violin/Cello Rock School Music Technology Other Student 2: Day (Please select only if one has been assigned)Not Assigned At This TimeSundayMondayTuesdayWednesdayThursdayFridaySaturdayStudent 2: Time (Please select only if one has been assigned)Not Assigned At This Time8:008:309:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PMInstructor (Please choose from dropdown menu)Peter CohanElizabeth AndersonErinn BrownRandy LeventhalDarren MuiseJohn McBreenRyan DavisonNat SimpkinsBethany VahnStudent 2 Start Date MM slash DD slash YYYY Additional InformationPlease select your method of payment. (We will contact you to finalize payment details). Monthly Auto Charge A Credit Card Each Month. (We do not except Debit Cards) Monthly Debit From A Checking Account Using ACH Processing Please add any additional information that you feel would be helpful.HiddenPromo Code PhoneThis field is for validation purposes and should be left unchanged. Δ Total Page Visits: 3718 - Today Page Visits: 6
