Student Information

Today's Date

How did you hear about us?

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Student's Name

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DOB

Student's School

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Grade

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Age

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Parent Information

Parent/Gaurdian Names:

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Address

Address Line 1

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Address Line 2

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City

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State

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Postal Code

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Country

Email Address

We will send confirmation to this email.

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Primary Phone

Enter your phone number for contact purposes.

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Secondary Phone

Enter your phone number for contact purposes.

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Class Selection

Prelude: Ages 0-13 months. Mondays 11:15-11:45 AM ($75/m)

Emergency Contact

Name

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Relationship

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Phone Number

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Programs

Student's Instrument

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Months/Years Experience

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Programs to Choose From

Private Drum lessons

Private Lessons

Piano Express ($115/month)

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Early Childhood

Choose Class Level

Prelude: 0-13 months Mondays 11:15-11:45 AM ($75/month)

Allegro: 14-28 months Mondays 9:15-10 AM ($85/month)

Presto: 29 months – 3.5 years Mondays 10:15-11 AM ($85/month)

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Private Lessons

Class Selection

Private Piano ($129/month)

Private Instrumental ($129/month)

Private Guitar ($129/month)

Private Voice/Singing ($129/month)

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I agree to a $40 materials for each level due with registration.

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I agree to a $25 materials fee.

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I agree to a $20 registration fee.

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I agree tuition payment is due on the 1st day of each month, and thereafter.

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Register for Lessons

Register today for Lessons

Student Information

Parent Information

Emergency Contact

Programs

Early Childhood

Private Lessons

Ready to Begin your Musical Journey?

Music Academy of York