Lesson Registration Information
Student Information
Student Name
*
First Name
Last Name
Student Date of Birth
*
-
Month
-
Day
Year
Date
Student Grade Level
Student Email
example@example.com
Contact Information
Parent/Guardian or Adult Student
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternate Contact Name
*
First Name
Last Name
Alternate Contact Email Address
*
example@example.com
Alternate Contact Phone Number
Lesson Information
Instrument of Interest
*
Desired Term
*
Note: Registration is ongoing and students can enroll at any time during the term.
Desired Lesson Duration
*
30 Minutes
45 Minutes
60 Minutes
Please list ALL available weekdays and times for the student's lessons
*
Example: Mondays 3-6pm, means student can start at 3pm but needs to finish by 6pm
If you have a preferred day and time please enter it here
Optional
Is there anything you would like to share about the student (e.g learning considerations, special needs)?
How did you hear about DSM?
Policies
Please review the DSM policies for families 2024-25 linked below
Review of DSM Policies
*
Check here to indicate you have read and agree with DSM policies.
Registration Fee
DSM Charges an annual registration fee of $30 per student, up to a maximum of $60 per family.
Acknowledgement of fees
*
Check here to acknowledge that you will be charged a $30 registration fee annually in addition to lesson and/or class tuition.
Photo & Video Permission
Does DSM have permission to use the student's photo(s) or video(s) on its website, social media and/or newsletter?
*
It is OK to use the student's photo or video
It is NOT OK to use the student's photo or video
Submit
Our office will contact you soon to confirm registration and facilitate scheduling. If you have any questions in the meantime, please call us at 781-441-9372 or email us at info@dedhamschoolofmusic.org.
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