First Name(s):

Last Name:

Email:

Home Phone:

Work/Cell Phone:

Street Address:

City:

State:

Zip:

How did you hear about us?:

Musical Training:

First Name:

Last Name:

Age:

Birthdate:

Preschool/School if enrolled:

Medical concerns/allergies:

First names and ages of siblings:

Musical Training:

Class Location:

Class Date:

Class Time:

Do you have materials for this class? (we will deduct $20):

Are you enrolling a sibling in any other Studio3Music class?: (We will deduct $20 for each additional child)

Would you like to contribute $5 to our scholarship fund?:

What is your preferred payment option?:

What is your preferred method of payment?:

If paying by credit card, would you like us to use the same card information that is currently on file?:

Mail checks to:
Analiisa Reichlin, Studio3Music, 4509 241st Street SW Mountlake Terrace, WA 98043

NOTE: $75 of the total fees are due with this registration and are NON-REFUNDABLE. By submitting this Registration, I hereby authorize Studio3Music to apply the total semester fees (less any discounts) to my credit card per the payment plan chosen, if I am paying by credit card. With this enrollment, I am committing to pay for the entire semester per the payment plan chosen. By submitting this registration, I waive and release Studio3Music, LLC and its affiliates, officers, members, employees, attorneys, representatives, successors and assigns (collectively, the "Releasees"), of and from, and promise never to institute, assert, prosecute or pursue, any and all claims, charges, liabilities, claims for relief, demands, suits, action or causes of action against the Releasees, whether based in contract or relating to personal injury or damage to property, arising during the course or as a result of this musical activity.

Additional Comments: