Melodyway Music

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 1st 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




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