OMBA_Registration

OMBA 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*

Cell Phone*

Student's Name*

Students Age*

OMBA Classroom Teacher's Name*

Music Class *

Do you need to purchase an instrument through OPMI? (You do not need a keyboard for MusicFirst)*

	YES
	NO

What instrument would you like to purchase?*

	Keyboard ($80)
	Drum Pad ($18)
	NONE

Where will your student go after their music class*

Approved Child Pick Up (Please list names, phone number and relation)

Do you authorize OPMI to use photos of your child on our website and/or promotional material?*

OPMI Payment Policy*

I understand that registration and tuition payments are non-refundable; OPMI does not prorate tuition fees due to student start date. Tuition is based on a flat annual fee that is divided into equal monthly payments for your convenience. Holidays, such as Thanksgiving Break, Spring Break, and Winter Break are factored into this fee. Months that have 5 weeks of class instead of 4 make up for the few missed classes due to holidays and breaks. Returning students are still required to pay the registration fee each year. Refunds will only be issued if a class is cancelled entirely due to low enrollment or other unforeseeable circumstances. Refunds will be issued via U.S. Mail. Refunds and/or tuition adjustments are not issued due to lack of attendance or missed classes, regardless of the reason.

OPMI Terms and Conditions*

I have read and agree to the OPMI Payment Policy regarding payments, cancellations, instrument requirements and child pick-up and I wish to register my child for this class. MusicFirst classes do not require instrument purchase. OPMI requires a 30 day withdraw notice that must be made in writing.

Liability Waiver*

BY CHECKING THIS BOX, I AGREE THAT I HAVE READ AND VOLUNTARILY SIGNED THIS AGREEMENT ELECTRONICALLY and further agree that no oral representation, statements, or inducement apart from the following written agreement has been made: IN CONSIDERATION, of being permitted to utilize the facilities, services and program of ORLANDO PREMIER MUSIC INSTRUCTION, herein after referred to as 'OPMI', for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with OPMI, the undersigned, for himself or herself and any personal representatives, heirs, children and next of kin, hereby acknowledges, agrees and represents that he or she releases OPMI and its staff members from all liability for an injury, loss or damage connected in any way whatsoever to participation in OPMI activities whether on or off of the premises affiliated with OPMI. He or she understands that this release includes any claims based on negligenc

Special Requests/Needs/Concerns: