After School Music Club Enrollment

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Student Name* This field is required.Student
First Name
Last Name
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Birthday* This field is required.We celebrate birthdays!
Date
Year
Month
Day
3
Student's Skill Level* This field is required.Beginner or Intermediate
Beginner
Intermediate
4
Parent / Guardian Name* This field is required.Parent or Guardian
First Name
Last Name
5
Phone Number* This field is required.Parent's Cel Phone Number
Please enter a valid phone number.
6
Alternate Phone Number* This field is required.In Case of Emergency
Please enter a valid phone number.
7
Email* This field is required.Best Email Address for MMM Updates and Notices
example@example.com
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Address* This field is required.Use Mailing Address for Zip Code Please
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
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
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
9
Terms and Conditions* This field is required.
10
I will sign the Practice Report weekly* This field is required.Initials
Clear
11
I'm aware of the Token Reward System* This field is required.Initials
Clear
12
We will participate in Performances and Field Trips* This field is required.Initials
Clear
13
I agree to the terms of the MEDIA RELEASE of Liability* This field is required.Signature
Clear
14
I agree to the General / Medical Release of Liability* This field is required.Signature
Clear
15
I agree to authorize automatic monthly payments on my first invoice for After School Music Club dues* This field is required.Signature
Clear
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How did you hear about us?* This field is required.Name of person who referred you and/or the platform where you found our info
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Dues and SuppliesDues & Essentials
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My Bag
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My Bag
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$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
TaxUSD
SubtotalUSD
Total costUSD
After School Music Club NOW INCLUDES TRANSPORTATION FROM SCHOOL TO MMM STUDIO. Select Beginner or Intermediate Groups meet 2 times per week plus BONUS Fridays are included for all students
$247.00+Edit
Back
Enrollment Package2 MMM Uniform T-shirts1 Green MMM Music Binder1 MMM Beginning Ukulele Workbook10 Tokens1 Token pouch
$99.00+Edit
Back
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XS
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M
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A-S
A-M
A-L
W-S
W-XL
Size
Subtotal: $0.00
Enter Coupon
Total cost $0.00
Credit Card
First Name
Last Name
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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 inquire at mauimusicmission@gmail.com to apply. Visit www.mauimusicmission.com to make a donation.
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