SMART SCHOOL REGISTRATION

SMART School Spring Registration

This form needs to be filled out per person
Total Cost: $441

For registration fees and a 15 week music course
Are you registering an adult or a child?
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Parents Name:

Parents First NameLast Name
Parents Cell Phone Number:

Area CodePhone Number
Parents Email
example@example.com
Students Name

First NameLast Name
Student Age

Music History

This is a quick questionnaire to get to know your musical background
Taken lessons before:
If so, how long?
How long have you played your instrument?
Do you own your own instrument at home?
Are you interested in private lessons?

Payment - Choose One:

SMART School Registration (Paid in Full)(USD one-time payment)

SMART School Registration (3 monthly payments)(USD for each month)

Payment Method
Credit

Credit Card Info
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

*This cost DOES include credit card fees charged by Paypal
Should be Empty: