Music Lesson Registration Form Download

Prepare your registration form in advance before coming into the store!

Download Music Lesson Registration Form (.PDF)

Student’s Name:
Student’s Birthdate:

Student’s Home Address:
City:
State:

Zipcode:

Phone (home):
Phone(work – adult students):

Adult Email Address:

Parent or Guardian’s name(s) and address(es) if under 18:
name:
relationship:

Street Address:

City:
State:

Zipcode:

Phone (home):
Phone (cell):

Phone (work):

Private Lessons in
(indicate which instrument)

30 Minutes ($24)

60 Minutes ($46)
Pre-paid on a Monthly Basis

Prior Experience:

Registered for Day:

Time:

Instructor:

Studio:

Acct#

How did you hear about JC Music’s Lesson Program?

Credit Card #
Exp. Date:

One Time registration fee – non-refundable $20 Or $30 per Family (if registering for more than one student at this time).

Cash

Check

Credit Card

Charged to Account

Please note: Registration Fee (non-refundable) is due by the first day of instruction. NOTE: The first Monthly fee will also be due at or prior to the first lesson. Please ask the JC Music staff for the amount due. Lesson payments must be paid on a monthly basis. We will not accept weekly or bi-weekly payments!

Students must cancel at least one day prior to a scheduled lesson to be given a lesson credit.
Recitals are offered every January/February and again in July.