Piano Teacher with kids exploring the Trumpet

2011-2012 Dance Year Enrollment Request Form

To enroll in classes for the 2011-2012 Dance Session, begin by completing the form below. You can review our current schedule here.

PLEASE NOTE: If the class you want is at the wrong time for you, please let us know your schedule needs by completing the "Additional Schedule Information" section of the form below. We appreciate your feedback!

Note that you may make online payments via eCheck or credit card, at https://www.musicplace.com/epay/ at any time.

Parent/Family Information:

Dad's First Name:

Dad's Last Name:

Mom's First Name:

Mom's Last Name:

* Best Contact Phone:

* Email:

* Street Address:

Apt #, PO Box, Etc:

* City:

* Zip Code:

If you were referred by an existing Music Place family, please enter their name & contact info (phone or email) here. This will ensure that they receive their $20 referral "Thank You" gift.

Referred by?

Student & Class Information:

Same As Above?

That's Me! (I'm an adult.)

* Student First:

* Student Last:

* Date of Birth:

Please enroll this Student in the following class:

* Class Name:

* Day:

* Time:

Additional Student or Class?

Student First:

Student Last:

Date of Birth:

Please enroll this Student in the following class:

Class Name:

Day:

Time:

Additional Student or Class?

Student First:

Student Last:

Date of Birth:

Please enroll this Student in the following class:

Class Name:

Day:

Time:

Additional Schedule Information:

Until classes fill up and are confirmed, schedules are subject to change. To help us accomodate as many students as possible, please include additional schedule/availability information below.

Also Interested In:

Best Days & Times:

Other Possibilities?:

Days/Times that would NOT work:

Special request or additional information about enrolled children, etc:

PLEASE NOTE: Completing enrollment is a 3-step process:

Complete the Enrollment Request Request Form above,
Complete the Release of liability form, and
Submit a $32.50 deposit for each child and any applicable Lifetime Registration Fees ($50.00 per family or $35.00 per individual)

We will contact you with details to finalize and confirm your enrollment. Thanks!!!

DANCE REGISTRATIONS COMPLETED ON OR BEFORE AUGUST 20th qualify for a $15.00 tuition credit.

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Last Modified: 2011.07.31

Actual Customer Testimonials:

"We have recommended to many of our friends. We love the place. It has totally helped our daughter to not only know the notes but to truly have fun with them! We love the teacher(s) and wish them all the very best. - " -- Happy parents

"Our daughter, Melissa, loves her music class, and she looks forward to the recitals. She's made friends and become more confident. We'd recommend the Music Place to anyone. -- Melissa's parents, Kathy & Matt, Los Gatos" .

I tell everyone who will listen about the amazing introduction to music that our daughter is getting with the Music Place. People are always amazed when a 3-year old explains that she played an oboe last week and is going to play a piccolo next week! Most importantly, our daughter can't wait for music class & asks to go every day. -- The Pace Family