Melodyway Music

Music is fun. One on one!

Piano Keyboard lessons from McMinnville Oregon 503-997-7897

Melodyway Class Registration Form

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

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

Please list and allergies or medical issues of which the teacher should be aware of:
To make sure you are real :
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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) 10% discount 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. A non-refundable $30 music and materials fee is required to start lessons.

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