Joyful Melodies Online Registration Form

Registration Fee ($40) Paid?   Yes   No Student Full Name Date of Birth Age Current School Grade/Year Billing Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Other... If Other, specify: Zip Code If student is over 18 years old, enter contact information. Cell Phone Home Phone Work Phone E-Mail Mother/Guardian Name E-Mail Cell Phone Home Phone Work Phone Father/Guardian Name E-Mail Cell Phone Home Phone Work Phone Describe the students prior musical education, if any. What are your musical goals and favorite song? Does anyone in the family play an instrument? Who? Best days and time for interview (including student and parent/ guardian) with school. How did you hear about Joyful Melodies? Program Enrollment:       Private Lessons       Group Lessons If you chose private lessons... Instrument       Weekly Lesson Length:       30   45   60 Start Date Instructor Location: Onsite @ Cupertine Location Offsite/Home Lesson @ above address Lesson @ this address: If you chose group lessons... Introductory Music Class (Age 2.5 to 4) Keyboard Class (Age 4 to 8, Adult) Guitar Class (Youth, Teen and Adult) String/Violin Ensemble (All Ages) Music Ensemble (Youth, Teens, Adult) Orff Program (age 4 to 13) Bilingual Chinese and English Music Class (2 to 4) Joyful Melodies Music Maker (Birth to 4) Other, please specify: Initial here to indicate you agree to Joyful Melodies Tuiton Policies and the Joyful Melodies Photo/Video Release Policy.