Melodyway Music Center

Sharing Joy. Making music. Since 1962!

Mailing Address
Post Office Box 220
Oregon City OR 97045

503-650-5080 – Oregon City
503-434-6404 – McMinnville
503-997-7897 – Salem

Melodyway Class Registration Form

Fields colored in red are required. Other fields are optional.

Student Information
Name:
Birthday:
Home Phone:
Cell Phone:
Email:
Home Address:
City:
State:	Zip:
School Attending:
Sibling #1 Name:
Sibling #2 Name:
Lesson Class Information (see schedule)
Lesson Start Date:
Lesson Time:
Class Name:
Parent #1 Information (required if student is a minor)
Name:
Email Address:
Home Phone:
Cell Phone:
Fax Number:
Address:
City:
State:	Zip:
Employer:
Work Schedule:	From: To:
Parent #2 Information (optional)
Name:
Email Address:
Home Phone:
Cell Phone:
Fax Number:
Address:
City:
State:	Zip:
Employer:
Work Schedule:	From: To:
How did you hear about us?

Please list and allergies or medical issues of which the teacher should be aware of:
Questions/Comments:
Terms and Conditions
I agree to pay tuition payments promptly by the following method. (select one) One Annual tuition payment (due by the first lesson) Two payments (one by the first lesson, one by the 24th lesson) Monthly payments (due by the 1^st day of each month) I have read the POLICIES of Melodyway Music Studios and I will abide by them. (Optional) Melodyway Music Studios may use photographs of my student on this website. If, for any reason, the student wishes to quit the course before completion, I will provide 30-days notice, and will pay through the end of the 30 day period in which the student terminates. A non-refundable Annual Registration Fee of $30 is required upon registration. Please make checks payable to Melodyway Center, PO Box 220, Oregon City OR 97045

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