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.
Parent/Guardian First Name*
Parent/Guardian Last Name*
Student's First and Last Name*
Classroom Teacher's Name
Music Class *
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?*
Where will your student go after their music class*
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?*
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.
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