Music Lessons Express Online Registration

Registration

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Please fill out your preference of instrument, location (home/studio), and lesson day and time in the comments section below.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Home Phone *

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School

Grade Level

Selecting a class is optional. If you do not see your class or special program listed do not worry. Once we receive this form we will get you enrolled in the class or program you want.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School

Grade Level

Selecting a class is optional. If you do not see your class or special program listed do not worry. Once we receive this form we will get you enrolled in the class or program you want.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School

Grade Level

Selecting a class is optional. If you do not see your class or special program listed do not worry. Once we receive this form we will get you enrolled in the class or program you want.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School

Grade Level

Selecting a class is optional. If you do not see your class or special program listed do not worry. Once we receive this form we will get you enrolled in the class or program you want.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School

Grade Level

Selecting a class is optional. If you do not see your class or special program listed do not worry. Once we receive this form we will get you enrolled in the class or program you want.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Payment Information

Payments are processed on the first of each month for that month's lessons (Example: payments processed on July 1 are for July lessons). There are no partial payments. Lessons are month to month; lessons may be discontinued at any time and lessons will cease at the end of that month (Example: MLE is notified on July 5 that lessons are being discontinued; lessons then end on July 30). There are no refunds and MLE must be notified in writing (via email or letter) to end lessons and charges.

Missed lessons can be made up at the instructor's discretion only if 24 hours advance notice is provided to the instructor.

There is a $35 registration fee for regular monthly lessons. This fee is waived for additional household members. If there is an interruption in lessons of a month or more you will need to re-register (and pay the registration fee).

Thank you!

I've read the above and agree.

Home Lessons

for underage students if you choose in home lessons an adult must be present at all times.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number