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) *

Number of Lessons

Location *

Classes / Workshops *

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

($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 Names *

Cell Phone *

Home Phone

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? *

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

Summer Registration Form