Registration

1.) ALL STUDENTS MUST REGISTER ONLINE, including siblings.
2.) Fill out the form below and submit.
3.) When registering for multiple sessions of one class, please put name of session in preferred day space (e.g. Winter or Spring)
4.) You will receive a confirmation notice and information about payment options.
5.) FRIEND REFERRALS - Were you referred by a current family? Please write their name on the registration form in the "Comment Box." You will both receive $10 off tuition for the registered SESSION. (NOTE: credit is only given if BOTH families are registered!)
6.) MATERIALS: Family materials are required for all classes and lesson. Teacher will hand out materials during the first week of class.
7.) Class Registration Fees may be paid in the following ways:

Pal Pal Link; PayPal.Me/musicwell OR Venmo @Beth-Marshall-135. Note for this option; bank transfers and transactions "between friends" are preferred. Any transation fees associated with "payment for service" or credit card will be added to the customer account.
Personal check payable to Music Well, LLC mailed or dropped off at Home Studio: 212 Edward Street, Verona, WI 53593

Select Class:

Preferred Day/Time:	(e.g. Tuesdays 09:30)
Preferred Location:
Family Materials:

Parent's First Name:
Parent's Last Name:
Address Line 1:
Address Line 2:
City:
State/Province:
Zip/Postal Code:
Email Address:
Home Phone Number:	- -
Work Phone Number:	- -
Cell Phone Number:	- -

Alt. Contact Person:
Alt. Contact Phone:	- -

Child's First Name:
Child's Last Name:
Child's Current Age:	months years
Child's Birthdate:	(MM/DD/YYYY)

May I have your permission to use pictures of your child in advertising?
	Yes No Pictures may be on our website and/or Facebook, but no names are ever disclosed.

List any allergies or medical issues of which the teacher should be aware:


How did you hear about us?:

Other:

Question/Comment: