After School Music Club Enrollment

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Student Name* This field is required.Student
First Name
Last Name
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Parent / Guardian Name* This field is required.Parent or Guardian
First Name
Last Name
3
Phone Number* This field is required.Parent's Cel Phone Number
Please enter a valid phone number.
4
EmailBest email address for updates & reminders
example@example.com
5
Street AddressLet us know where you live. If you've been displaced then tell us where you stay now. Or, please provide a mailing address.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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Afghanistan
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Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
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The Bahamas
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Laos
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Luxembourg
Macau
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Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
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Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
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Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
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eSwatini
Sweden
Switzerland
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Taiwan
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Tanzania
Thailand
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Togo
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Wallis and Futuna
Western Sahara
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Other
Country
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Terms of Enrollment* This field is required.
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SignaturePlease enroll my child in the After School Music Club. I agree to the Terms of Enrollment and Release of Liabilities.
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ASMC Tuition* This field is required.
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ORDER SUMMARY
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SubtotalUSD
Total costUSD
ASMC TuitionIncludes 6+hours each weekPiano, Ukulele, & Performance. Includes a FREE RIDE from select schools to our J. Walter Cameron Center studio
$247.00Edit
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Total cost $0.00
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Maui Music Mission is. 501c3 non-profit corporation which does not discriminate on the basis of reace, color, national origin, sex, disability, or age and provides equal access.

Maui Music Mission offer's a limited number of sponsorships each year to dedicated young musicians who cannot otherwise afford tuition. Please visit www.mauimusicmission.com to make a donation.
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