FALL 2023 - HMS Registration Form

HARMONY MUSIC SCHOOL

FALL 2023 Registration FORM
Student Last Name*
Student First Name*
Student D.O.B.*

MonthDayYear
Date
Address*
City*
State*
Zip*
Parent 1 - Name*
Home Phone Number*

Phone NumberPhone Number
Parent 1 Cell Phone
Parent 1 -Work Phone
Parent 1 - Email Address*
example@example.com
Parent 2 - Name
Parent 2 - Cell Phone
Parent 2 - Work Phone
Parent 2 - Email Address
example@example.com
Select Lessons Option:*

30 min x 15 Private Lessons - $57545 min x 15 Private Lessons - $72560 min x 15 Private Lessons - $860
Instrument Selection for 30 min:
Instrument Selection for 45 min:
Instrument Selection for 60 min:
Student Status:*
No. of Payments*

1 Payment, Early-Bird by 8/101 Payment after 8/112 Payments, due 8/31 & 10/15
Tuition Subtotal 1:
(Auto-Calculated based on your selections)
Tuition Subtotal 2:
(Auto-Calculated based on your selections)
Total Due with Registration Fee or Late Fee:
(Auto-Calculated based on your selections)
REGISTRATION OPTIONS:

1) In-Person: Bring Registration Form with payment to class, cash or check payable to “Suhoy LLC”.

2) By Email: Send a photocopy of both sides of your check to music@bmsmd.org.

3) By Zelle: Email Registration Form to music@bmsmd.org. Send funds via Zelle transfer to music@bmsmd.org.
I consent and agree that the above student's name, picture, voice, or video may be used by Harmony Music School of Suhoy LLC for school publications, on the school Internet website, in school-related video productions, or for news and other publications. I hereby release Harmony Music School of Suhoy LLC and all of its officers, directors, and employees from all liability for personal injury, illness, or property damage occurring on or off Harmony Music School premises. I have read, understand, and agree to all Harmony Music School Policies and Procedures published at http://bmsmd.org
Parent Signature:*

Clear
Date:*

MonthDayYear
Date
Should be Empty:

HARMONY MUSIC SCHOOL