"RAPID REGISTRATION" Form

To register, simply print out a policy agreement (Click here to obtain Policy Brochure & Signature page) and one copy of this page for each enrolling student, then PLEASE PRINT LEGIBLY and mail the completed form(s) to:

The Music Place
1617 Willowhurst Ave.
San Jose, CA 95125
or FAX to (408) 445-2806

New families should include an individual ($30.) or family ($50.) lifetime registration fee. This registration fee is non-refundable. (You are encouraged to read our complete Payment Policies.).

To obtain form to sign up for automatic payment deductions, click here: Form to Sign up for Automatic Payment Deductions   

For instructions to pay online, click here: Make a Payment

STUDENT INFORMATION:
 Student's Name:  Date of Birth:
 M / F
 School Attending:
 Grade:
 Please print additional pages for each student enrolling!

FAMILY INFORMATION:
 Mother's Name
  (Last, First):
  Home Phone:
 Father's Name
  (Last, First):
 Work Phone:
 Alternate Contact:  Alternate Phone:
 Street Address:  
 City, State, Zip:  E-mail Address:
 Referred By:  Any religious preference?

SELECT DESIRED CLASS(ES):
 PLEASE COMPLETE THE FOLLOWING:
 X 
  Type  Length  Tuition  Time  Day  Location
 
  EMA  45 min  $70/month      
 
  EMA  30 min  $60/month      
 
  IRC  45-50 min  $175 for 10 wks;
    + $30 xylophone req'd.		      
 
  Family Class  30 min
  $60/month      
 
  Vocal Ensemble   45 min  $70/month      
 
  AllArts (ages 4-7)
  45 min  $70/month      
   Private Lessons*  30 min  $75-$130/mo (varies by teacher)      
* verify times, instructors and locations with our office

For Office Use Only:

Reg _________ Notify _____ Confirm Form ___________ ACH entered_____
Enroll ______ Memo _______ Schedule ____ Email _____