SUMMER LESSON REGISTRATION 

Summer Session:  July 2 through August 16

Registering for our Summer Lesson Program 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  for our Summer Music Lesson Program as well as your invoice. (Click here for our Music+Arts Summer Camp.)

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.
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 Tues 3:00 - 9:00 pm Yan Falmagne Tues 3:00 - 9:00 pm
Elise Espinosa Wed/ Thur 3:00 - 9:00 pm
Carl Burnett               Wed 3:00 - 9:00 pm
Nelson Silva              Wed- Thurs    3:00 - 9:00 pm
Christianna Lee Thur 5:00 - 9:00 pm
1st PREFFERED DAY/TIME
2nd PREFERRED DAY/TIME
3rd PREFERRED DAY/TIME
CLASSES + GROUP INSTRUCTION
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**
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.