Payment is required before registration is complete!

Online Registration Form

First Name (Student's):

Last Name:

Address:   Apt #:

City:   State: AZ   Zip:

Home phone:

Cell phone: 

Work phone:

email: 

Class Description:  Private Lessons Group Lessons Suzuki Violin Group Orchestra Preludes Class Flute Camp Band Camp Music Camp   Instrument:  Violin Viola Cello String Bass Flute Oboe Clarinet Saxophone Bassoon Trumpet Horn Trombone Baritone/Euphonium Tuba Percussion Piano Guitar Other None

Tuition amount:  $

IF STUDENT IS 18 years old or younger, please fill out the following:

Mother's Name:   Mother's work phone:  

Father's Name:    Father's work phone:

School now attending:  

Date of Birth (mm/dd/yyyy): 

Additional Information or Comments:

By submitting this form, you are agreeing to all PLACe polices and accept complete responsibility for all charges and fees that may be incurred. Consent is hereby given by/for the student, for the use of photographs without compensation, used for PLACe approved publicity purposes.

YES, I accept these terms.

Don't forget to make your payment before registration is complete!