CLASS ENROLLMENT FORM

The Palos Verdes Music Center
43C Peninsula Center, Palos Verdes, CA 90274 (310) 377-7838

CLASS ENROLLMENT FORM

Check Number___________________ MC / Visa____________________ Cash__________________

Class _____________________________________ Dates of Class ____________________________

Class Day _________________________________ Class Time _______________________________

Teacher Name _______________________________________________________________________

Students Name __________________________________________ Age ___ Birth Date ___________

Parent or Guardians Name __________________________ Signature __________________________

Address_____________________________________________________________________________

City ________________________________________________ State ___________ Zip ____________

Home Phone __________________________ Work Phone ___________________________________

Amount $ ______________ Enroller ________________________________ Date _________________

How did you learn about our classes?_____________________________________________________

Will you need to rent an instrument? ___ Yes ___ No

Tuition for group lessons is refundable or transferable only if a class is cancelled. Tuition is not pro-rated for late or abbreviated enrollment.
There are no provisions for making up missed group lessons. Coupons will be accepted at time of enrollment only. Students enrolled at AMUSE,
The Palos Verdes Music Center, are entitled to a 10% discount on regularly priced instruments, accessories, printed music, and gifts.