REGISTER 2017/18

Registration is fast, secure and easy. Please complete one form per student. If you have difficulty completing the registration or have any questions, please feel free to contact us at 845-405-3615. After receiving the form, we will contact you with Day/Time/Teacher information and invoice.

Student Name *
Student Name
Date of Birth *
Date of Birth
Address *
Address
Primary Phone Number *
Primary Phone Number
Emergency Phone Contact *
Emergency Phone Contact
Parents/Guardians *
Parents/Guardians
Parents/Guardians
Parents/Guardians
Allergies, etc.
How did you find out about Rivertown Music?Checkbox
Were you referred by someone?
Were you referred by someone?
If yes, please let us know their name.
Program Selection
Private Lessons
Private Lessons and Enrichment
Buddy Lessons
Tuition is listed per student.
IF YOU'RE TAKING A BUDDY CLASS, PLEASE INDICATE YOUR BUDDY.
IF YOU'RE TAKING A BUDDY CLASS, PLEASE INDICATE YOUR BUDDY.
If not, skip to the next question.
Christopher Yates    Monday/Tuesday    3:00 - 9:00 pm
Yan Falmagne Monday/Tuesday    3:00 - 9:00 pm
John Merrill Wednesday    3:00 - 9:00 pm
Nelson Silva Wednesday 3:00 - 9:00 pm
Elise Espinosa Monday/Thursday 3:00 - 9:00pm Stephanie Chan Monday/Thursday 3:00 - 9:00pm
1st PREFFERED DAY/TIME
2nd PREFERRED DAY/TIME
3rd PREFERRED DAY/TIME
CLASSES + GROUP INSTRUCTION
All classes are scheduled for 17 sessions and have a 4 student limit unless otherwise noted. *Indicates a $10 materials fee included in class tuition.*
JOYFUL SOUNDS PIANO (Ages 3-5)
BEGINNER GROUP PIANO (Ages 4-6)
Thurs 3:00-3:45pm **4 student limit**
BEGINNER GROUP PIANO (Ages 6-9)
Tues 3:45-4:30pm **4 student limit**
PAYMENT OPTIONS
ACH Payments
YEAR IN FULL
$30 registration fee is waived
SEMESTER IN FULL
MONTHLY PAYMENT PLAN
PHOTO WAIVER *
Occasionally. Rivertown Music prints and publishes promotional materials. Please select appropriately:
By signing below, I certify that I have read the studio policies found on the Rivertown Music website's policies page (below). I agree to abide by all policies described and I understand that due to contractual obligations, Rivertown Music cannot make exceptions to its policies.