Summer Registration - Worcester Music Academy

Payment must be received in full prior to start of lessons or workshops.

Name *

First

Last

Age *

Instrument(s) *

Preferred Lesson Days and Times (please list at least 3): *

Lesson Length (please choose one) *

30 minutes
45 minutes
60 minutes

Number of Lessons *

Location *

Worcester
Holden (not available in summer)

Do you need an instrument rental? (if so we will send you a rental contract upon receipt of your registration)

Yes
No

Classes/Workshops

Would you like to pre-register for the fall to secure a spot in your teacher’s studio? *

Yes
No

($70 due by June 13 to pre-register – non-refundable)

If pre-registering: please list any preferences for fall lesson days/times (this does not guarantee you will get this day/time):

Parents/Guardians Names (if applicable) *

Phone (Main) *

Phone (Secondary)

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

How did you hear about our school? *

Have your read and agreed to our Policies? *

Yes
No

Have you read and agree to our Student and Parent Expectations? *

Yes
No

By signing, you certify that you have read the policies, procedures and expectations and agree to abide by all the terms as outlined by the Worcester Music Academy. *

Signature

Date *

Summer Registration Form

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