This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in
Tildenville 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*
Home Phone*
Student's First and Last Name*
Grade*
---Select---
K
1
2
3
4
5
Classroom Teacher's Name
Music Class *
---Select---
Dance FX - Mondays 3:15-4:15
Guitar - Tuesdays 3:15-4:15pm
Vocal Expressions - Thursdays 3:15-4:15pm
Piano - Thursdays 3:15-4:15pm
Intro To Drama - Thursdays 3:15-4:15pm
Do you need to purchase an instrument through OPMI?*
---Select---
Guitar
Keyboard
NO
Where will your student go after their music class*
---Select---
ASP
Parent Pick-Up
Walker/Bike Rider
Additional Authorized Child Pick Up (Please list names, phone numbers, and relation to the child)
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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