Piano Teacher with kids exploring the Trumpet

Summer CLASS REQUEST Form

Please provide your information and desired class or workshop selection below. For more than one, please submit multiple forms.

Please note that you must receive a confirmation before the class begins. You should not attend until you receive this confirmation!

Parent & Emergency Contacts Info:

* Father's First:

* Father's Last:

* Mother's First:

* Mother's Last:

* Home Phone:

* Cell Phone:

* Email Address:

* Confirm Email:

* Street Address:

Apt #, PO Box, Etc:

* City:

* Zip Code:

Emergency Contact Info:

* Name:

* Relationship:

* Phone (during class hours):

Student #1 Information:

* Student First:

* Student Last:

* Date of Birth:

Grade Entering:

* Gender:

Male

Female

Student #2 Information:

Student First:

Student Last:

Date of Birth:

Grade Entering:

Gender:

Male

Female

Class Selection:

* Class Type:

* Class Day:

* Class Time:

* Class Cost:

* Location:

Coupon or Voucher Number?

Consent to Release of Liability:

Physical activities such as dance, drama and musical theater carry a risk of injury to participants.

I hereby release The Music Place and/or Soaring Spirit Dance Studio of any liability whatsoever arising out of any injury, damage or loss which may be sustained by myself, my minor children, or any other family members, during the course of involvement with The Music Place and/or Soaring Spirit Dance Studio. This includes activities held in any studio, classroom, theater or performance location during lessons, classes, performances or rehearsals and during any other activities sponsored by The Music Place and/or Soaring Spirit Dance Studio.

I have read this waiver agreement, understand its contents, and accept and assume such risks.

* Full Name:

* Email Address:

Name of Class Attendee(s):

I am parent or legal guardian of minor students named above

Yes

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Last Modified: 2013.06.05T22:46:10

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