Melodyway Music

Music is fun. One on one. Since 1962!

Oregon City, Portland, Beaverton, McMinnville 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 :
5 + 4 =
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. (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 $60 is required upon registration. Please make checks payable to Melodyway Music LLC, PO Box 631, McMinnville OR 97128

· ·