Afterschool Entrichment Registration And Payment Form

Afterschool Entrichment Registration And Payment Form
Parent(s) Name(s)*
Email Address*
Student's Name*
Student's Gender*

MaleFemale
Student's Birthday*
Contact Number*
Do you recieve Text at this number?*

YesNo
Address*
City*
Zip Code*
Emergency Contact*

First NameLast NameRelationship to student
Phone Number*

Area CodePhone Number
My Products
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After School Enrichment Class$130.00
6 week group guitar class

Total $0.00
Please Select your Preferred Session*

Modern Group GuitarTraditional Group Guitar
Please click yes if you WILL give permission to have photographs of your child taken*

YesNoOnly for my personal update/emails etc.
Tuition is due before the first day of class. For your convenience, payments may be submitted using the PayPal button provided below.
We occasionally take pictures of the kids in action with the materials or doing other activities for our website and/or blog. We hope to use these to keep parents up to date on the happenings at school.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.