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

None

Would you like to pre-register for the fall to secure a spot in your teacher’s studio? $70 non-refundable deposit due by June 20 ($50 for each additional child) *

Yes
No

($70 due by June 20 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

We use text messaging to communicate with you about lessons, schedules, reminders and other updates. By checking this box, I agree to receive text messages at the number provided from Worcester Music Academy regarding our programs. Message frequency may vary. Message and data rates may apply. Text HELP for help and STOP to opt out. Privacy Policy and Mobile Terms of Service can be found here: https://worcestermusicacademy.com/privacy-policy-2/

I agree to receive text messages from Worcester Music Academy

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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