Music Beginnings Registration Form

The 2-day morning session is for children who are 3 by 9/1/2024. All other sessions are for children who are 4 by 9/1/2024. Two-day classes: Tues/Thurs. Three-day classes: Mon/Wed/Fri. Class size: 10. Openings updated manually by Miss Raya, actual spots may vary.

Student's First name

Students Last name

Student's Gender

Student's Birthday

Month

Day

Year

Preferred Email Address

Most important class information is communicated via email. Miss Raya and the preschool teacher will use this email address to contact you.

Parent's Name

Full Mailing Address (Including Zip Code)

Preferred Phone #

This will be the number we call first if we need to contact you during class.

Secondary Phone

Whose Phone Number Is Above?

List any allergies, health concerns, or anything we should know about your child(ren).

Is there anything else we need to know about your child?

Include other information, concerns, or requests here.

Initial the box below to show agreement: Pick up and Drop Off

I will drop my child off no earlier than 5 minutes before class. I will pick up my child promptly at the end of class. I will watch for other children when driving and will refrain from blocking the road or sidewalk. If I am late for pick up, I will call or text the teacher.

Type your name in the box below to sign this release: Photographs

I grant permission to PB to use photos and/or video of me and/or my child for use on their website, Instagram, Facebook page, etc. I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation on arising from or related to the use of the image.

I may request the discontinuance of any photo or video.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

While we strive to maintain a safe environment, Piano Beginnings involves physical movement & outdoor play equipment. By enrolling in Piano Beginnings, I, the parent or legal guardian, accept full financial liability for any accident, injury, or illness that could occur to my child, myself, or any accompanying guest while on Raya Leavitt Blackburn’s property. I release Raya Grace LLC, Raya Leavitt Blackburn, all her heirs & connections, teachers, employees, and guests from all liability.

Please check all three boxes, indicating that you have read these items and agree. Once you submit this form, you will receive an email with the link to pay the $140 registration fee ($20 less if you register in January).

I understand that I need to pay the registration fee to secure my spot.

I understand that this fee is non-refundable.

I know that the link to pay will appear AND be sent via email as soon as I submit this form.

Multi choice

Option 1

Option 2

Single choice

Option 1

Option 2

Would you like more information? (Select All That Apply)

Group Piano in the Fall: I have a 4-8 year old who is interested in starting group piano classes (MVP) this fall

Private Lessons ages 6-99 Now: I am interested in private lessons (voice, piano, guitar, flute, or ukulele) starting right now!

Private Lessons ages 6-99 in the Fall: I am interested in private lessons for ages 6-99 (voice, piano, guitar, flute, or ukulele) starting in the fall!

Other

Music Preschool Registration Form

Music Beginnings Registration Form

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