Saturday Registration Form

Registration Form

Saturdays from 04/01/2023-05/27/2023. Located at 6843 S. Harper Chicago, IL
Are you a new or returning participant?*

NewReturning
Participant Name*

First NameLast Name
Gender*
Birthdate*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Choose your communication preference for updates/reminders. Please select all that apply.*

Phone CallText MessageEmail

Program Information

All lessons listed below are for group sessions. $50 Instrument rentals are available in the office for most instruments.
10:30 AM - 12:00 PM

Beginner Piano

Beginner Guitar

Dance

12:30 PM - 2:00 PM

Brass

Intermediate Piano

Intermediate Guitar

2:30 PM - 4:00 PM

Clarinet

Percussion/Drumline
Select Your Program(s)*

Beginner PianoBeginner GuitarDanceBrassIntermediate PianoIntermediate GuitarClarinetPercussion/Drumline

Terms & Agreements
I and/or my children agree to abide by the program rules, and may be asked to leave class if disruptive behavior is exhibited. Acts of violence will not be tolerated as it is a direct violation of Music Box Foundation's Code of Conduct. Such behavior may result in the the immediate dismal from the program.*

I Agree
I hereby give permission to Music Box Foundation for use of any photos, audio, and/or video in which my child(ren) may appear. The usage is inclusive of, but not limited to, the publication or inclusion in brochures, posters, catalogs, handbooks, banners, websites, and broadcast or print advertisements. I agree to waive any claim to compensation for use of said photos.*

I Agree
Attendance is crucial to success. I understand that consistent attendance at the session is crucial to the program’s success, and will make every effort to insure the participant is present for all class meetings and scheduled performances. In the event that my child(ren) is unable to attend a class or must leave early, I agree to inform Music Box Foundation with as much advance notice as possible. I understand that failure to attend class consistently, the participant may be dismissed from the program or ineligible to play in the final performance. I have read and agreed to all the information contained in this agreement. I agree to allow my information to be used in aggregate for reporting and analysis on this program.*

I Agree
Payment Options
$100 for new students

$60 for returning students

A non-refundable $25 fee is required in order to register. Participants have the option to submit a full payment at the end of this form or establish a payment plan with the office.
*

I understand

Payment Submission*

Registration Fee

$25.00

New Student Program

$100.00

Returning Student Program

$60.00

Payment Plan

$ Free

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Should be Empty:

Registration Form

Parent/Guardian Information

Program Information

Terms & Agreements

Payment Options

Payment Methods