"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.

In addition, families who do not sign up for eCheck automatic Payment plan (below)**should include a refundable $30.00 group class Notice Guarantee Fee ($40.00 for 30-minute private lessons) per child, per class. Notice Guarantee Fees are refundable with proper withdrawal notice.

**PLEASE NOTE: NOTICE GUARANTEE FEES ARE WAIVED for families who sign up for monthly eCheck Automatic Payment Deductions.For more information  see our policy brochure. 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 _____