Beginner Piano Class
Fridays 11:20-12:20pm
This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in
Little Orange Academy After-School Music Class Registration Form
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-Mail Address*
Street Address*
City*
Home Phone*
Student's Name*
Age*
---Select---
4
5
Music Class *
---Select---
Piano - Fridays @ 11:20am
Do you need to purchase an instrument through OPMI?*
---Select---
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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