harmonic music studios
REGISTRATION FORM
Student 1 Name
*
First Name
Last Name
Birth Date - Student 1
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Birth Date - Student 1
*
-
Month
-
Day
Year
Date
Student 1 Preferred Pronouns
*
She/Her
He/Him
They
Other
Student 1 Email
*
example@example.com
Student 1 Cell Phone Number
-
Area Code
Phone Number
Student 1 Grade
*
Adult
Preschool
Pre K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Grad School
Student 1 School
Student 1 Choice of Instrument
*
Voice
Piano
Harp
Violin
Viola
Cello
Upright Bass
Guitar
Electric Guitar
Electric Bass
Ukulele
Trumpet
Tuba
Trombone
Euphonium
Flute
Clarinet
Saxophone
Recorder
Oboe
Drums
Accordion
Undecided
Can select multiple instruments
Preferred Teacher(s) for Student 1
Clarify which teacher for which instrument
Student 1 Lessons will be:
*
Virtual
In Person
Preferred Lesson Day - Student 1
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Lesson Time - Student 1
*
Please select a time Mondays-Fridays between 2pm and 8pm or Saturdays between 10am and 3pm.
Length of Lesson - Student 1
*
30 minutes
60 minutes
Additional information about Student 1
Click to Add Another Student
Name - Student 2
First Name
Last Name
Birth Date - Student 2
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Student 2 Preferred Pronouns
She/Her
He/Him
They
Other
Student 2 Email
example@example.com
Student 2 Cell Phone Number
-
Area Code
Phone Number
Student 2 Grade
Adult
Preschool
Pre K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Grad School
Student 2 School
Choice of Instrument for Student 2
Voice
Piano
Harp
Violin
Viola
Cello
Upright Bass
Guitar
Electric Guitar
Electric Bass
Ukulele
Trumpet
Tuba
Trombone
Euphonium
Flute
Clarinet
Saxophone
Recorder
Oboe
Drums
Accordion
Undecided
Can select multiple instruments
Preferred Teacher(s) for Student 2
Clarify which teacher for which instrument
Student 2 Lessons will be:
Virtual
In Person
Preferred Lesson Day - Student 2
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Lesson Time - Student 2
Please select a time Mondays-Fridays between 2pm and 8pm or Saturdays between 10am and 3pm.
Length of Lesson - Student 2
30 minutes
60 minutes
Additional information about Student 2
Click to add a 3rd Student
Student 3 Name
First Name
Last Name
Student 3 Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Student 3 Preferred Pronouns
She/Her
He/Him
They
Other
Student 3 Email
example@example.com
Student 3 Cell Phone Number
-
Area Code
Phone Number
Student 3 Grade
Adult
Preschool
Pre K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Grad School
Student 3 School
Choice of Instrument for Student 3
Voice
Piano
Harp
Violin
Viola
Cello
Upright Bass
Guitar
Electric Guitar
Electric Bass
Ukulele
Trumpet
Tuba
Trombone
Euphonium
Flute
Clarinet
Saxophone
Recorder
Oboe
Drums
Accordion
Undecided
Can select multiple instruments
Preferred Teacher(s) for Student 3
Clarify which teacher for which instrument
Student 3 Lessons will be:
Virtual
In Person
Preferred Lesson Day - Student 3
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Lesson Time - Student 3
Please select a time Mondays-Fridays between 2pm and 8pm or Saturdays between 10am and 3pm.
Length of Lesson - Student 3
30 minutes
60 minutes
Additional information about Student 3
Click to add a 4th Student
Student 4 Name
First Name
Last Name
Student 4 Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Student 4 Preferred Pronouns
She/Her
He/Him
They
Other
Student 4 Email
example@example.com
Student 4 Cell Phone Number
-
Area Code
Phone Number
Student 4 Grade
Adult
Preschool
Pre K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Grad School
Student 4 School
Choice of Instrument for Student 4
Voice
Piano
Harp
Violin
Viola
Cello
Upright Bass
Guitar
Electric Guitar
Electric Bass
Ukulele
Trumpet
Tuba
Trombone
Euphonium
Flute
Clarinet
Saxophone
Recorder
Oboe
Drums
Accordion
Undecided
Can select multiple instruments
Preferred Teacher(s) for Student 4
Clarify which teacher for which instrument
Student 4 Lessons will be:
Virtual
In Person
Preferred Lesson Day - Student 4
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Lesson Time - Student 4
Please select a time Mondays-Fridays between 2pm and 8pm or Saturdays between 10am and 3pm.
Length of Lesson - Student 4
30 minutes
60 minutes
Additional information about Student 4
Family Contact Information
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Adult 1 Name
*
First Name
Last Name
Adult 1 Relationship to Student
*
Adult 1 will receive all student lesson notifications and reminders. To have them go to a different email or cell phone please let us know below.
Adult 1 Email
*
example@example.com
Adult 1 Phone Number
*
-
Area Code
Phone Number
Adult 2 Name
First Name
Last Name
Adult 2 Relationship to Student
Adult 2 Phone Number
-
Area Code
Phone Number
Adult 2 Email
example@example.com
Emergency Contact Information
Please include the contact info of any another adult (like a nanny) who will be with your child during virtual lessons, or doing drop off/pickup.
Release of Liability: As the legal parent or guardian, I release and hold Harmonic Music Foundation, Inc., its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Harmonic Music Foundation, its owners and operators, or in route to or from any of said premises.
*
I've read the above and agree.
Lesson Cancellations/Make-up Policy: Lesson Cancellations/Make-up Policy: There are no single lesson cancellations. You can reschedule lessons with more than 24 hours notice and that make up lesson must take place within two weeks of the original lesson. If you would like to cancel all lessons going forward, we require 24 hours of notice. You may request a one (1) time cancellation for one (1) lesson if your child's spring break does not align with when harmonic is closed. Lessons do not automatically stop at any time. Until we are given notice that you would like to stop lessons, they will continue through semesters, seasons, and into the summer.
*
I've read the above and agree
Sick Policy: For in person lessons, if you are sick, not feeling well, have a fever, cough, or have been exposed to someone with Covid-19 please stay home. Please contact us before the start time of your lesson and we will reschedule your lesson. If you arrive at harmonic sick and have to be asked to leave, you will still be charged for your lesson. We reserve the right to ask you to leave if you are sick and may endanger our staff and community. For virtual lessons, if you are sick and unable to attend your lesson, please contact us before the start time of your lesson so we can reschedule.
*
I've read the above and agree
Payment Information: Payment will be collected after each lesson by charging the credit card we have on file. If the credit card is declined, we will send a digital invoice for you to pay upon receipt. If payment is not collected within 7 days you will forfeit your spot on the schedule with your chosen teacher, day, and time.
*
I've read the above and agree
Signature
*
Release to keep credit card information on file
Submit
Should be Empty: