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Registration Form Date of application________________
Print this form, complete and fax to 412.441.5098 or mail to Karen Sloneker, PO Box 90004, Pittsburgh, PA 15224
Paid registrations are accepted in the order that they are received. If you prefer to pay by check or electronic invoice, fax the registration form and we'll hold your spot for 3 business days.
Child's Name_________________________________________________________________________________
Birthdate___________________________________Entering grade in Fall 2009__________________________
Second Child's Name__________________________________________________________________________
Birthdate___________________________________Entering grade in Fall 2009__________________________
Third Child's Name____________________________________________________________________________
Birthdate___________________________________Entering grade in Fall 2009__________________________
Parent_____________________________________________________________________________________
Address____________________________________________________________________________________
Phone____________________________________Alternate phone (home or cell)________________________
email address_______________________________________________________________________________
Group Piano Class
Wilkins School Community Center
Ages 7 - 10 Ages 11 - 13
Monday Monday
______1:30 PM _______12:30 PM
World Music Drumming
Wilkins School Community Center
Ages 7 - 10 Ages 11 - 12 Monday Monday
_____2:30 PM _____7:00 PM
Payment information:
Register for one class @$160; two classes @$150/class. Discount can also be applied to sibling registrations.
Piano will incur a materials fee of $20.00, payable at the first class.
Class fee(s) $___________
One time registration fee of $15 per family $___________
Total enclosed with application $___________
_____Check enclosed made payable to "First Notes"
_____Please charge my credit card with the information below
_____Please send me an electronic invoice so that I can enter my credit card information myself or use my paypal account.
Visa/Mastercard (please circle) #____________________________________________________
Expiration date__________________________________Three digit security code____________
Signature_______________________________________________________________________
Please note: All of the above information, including email address, is necessary to process credit card payments. Thanks for your cooperation.
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Refund/cancellation policy: Please choose carefully and consider your family schedule. Withdrawals before the start of classes will be refunded in full, with the exception of the registration fee, which is nonrefundable. Credit toward an upcoming term will only be granted in exceptional circumstances, such as a death in the family, prolonged serious illness, and so forth.
Payments for classes cancelled due to low enrollment will be refunded in their entirety.
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To register for Music Together classes, visit www.mtfirstnotes.com.
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