Beginner Piano Class at
Bright Horizons Winter Garden
This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in
Bright Horizons After-School Music Class Registration Form
Please note that all fields followed by an asterisk must be filled in.
Parent/Guardian First Name*
Parent/Guardian Last Name*
E-Mail Address*
Street Address*
City*
Home Phone*
Student's Name*
Age*
---Select---
4
5
Music Class *
---Select---
Piano - Tuesdays @ 11:00am
Do you need to purchase an instrument through OPMI?*
---Select---
Guitar ($70.00)
Keyboard ($80.00)
NO
Where will your student go after their music class*
---Select---
With Classroom Teacher
Parent Pick-Up
Do you authorize OPMI to use photos of your child on our website and/or promotional material?*
---Select---
YES
NO
OPMI Terms and Conditions*
I have read and agree to the OPMI Terms and Conditions regarding payments, cancellations, instrument requirements and child pick-up and I wish to register my child for this class.
Special Requests/Needs/Concerns:
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