Register

Student Name*

First Last

Student is:*

Child
Teen
Adult

Parent Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about Flourish?

K-12 secondary emergency contact information

Please list name, relation, phone number and email

Does the secondary emergency contact wish to receive regular email/text communications (regarding schedule, recitals etc)?

Yes
No

Student birthdate*

Gender

Do you want your teenage child (if applicable) to receive regular parent communications (regarding scheduling, recital reminders, etc.)?

Yes
No

Student Email*

Student Phone

Primary Instrument*

piano
voice
guitar
ukulele
violin
viola
cello
bass guitar

Program you would like to enroll in for your primary instrument*

Accelerated Lab for Piano or Guitar (60 min)
Private 45 minute lessons
Private 60 minute lessons

Are you enrolling in an secondary instrument as well?*

Yes
No

Secondary Instrument*

piano
voice
guitar
ukulele
violin
viola
cello
bass guitar

Program you would like to enroll in for your secondary instrument*

Secondary instrument - Accelerated Lab
Secondary instrument - Private 45 min
Secondary instrument - Private 60 min

Is your intro lesson day/time finalized? If yes, please confirm the time you want

If your lesson time is not finalized, what days do you generally have available?

Please select all that apply so we can give you the most options for your lesson time.

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

If your lesson time is not finalized, what times do you generally have available?

Please select all that apply so we can give you the most options for your lesson time.

9am-12pm
12 - 2:30pm
2:30-3:45pm
3:45-5:15pm
5:15-6:45pm
6:45-8:15pm

Comments or preferences on your lesson time availability

I would like to register another student*

Yes
No

#2 Student Name*

First Last

#2 Student Birthdate

Gender

Do you want your teenage child (if applicable) to receive regular parent communications (regarding scheduling, recital reminders, etc.)?

Yes
No

Student Email*

Student Phone

Primary Instrument*

piano
voice
guitar
ukulele
violin
viola
cello
bass guitar

Program you would like to enroll in for your primary instrument*

Accelerated Lab for Piano or Guitar (60 min)
Private 45 minute lessons
Private 60 minute lessons

Are you enrolling in an secondary instrument as well (for Student #2)?*

Yes
No

Secondary Instrument*

piano
voice
guitar
ukulele
violin
viola
cello
bass guitar

Program you would like to enroll in for your secondary instrument*

Secondary instrument - Accelerated Lab
Secondary instrument - Private 45 min
Secondary instrument - Private 60 min

Is your intro lesson day/time finalized? If yes, please confirm the time you want

If your lesson time is not finalized, what days do you generally have available?

Please select all that apply so we can give you the most options for your lesson time

Same as student #1
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

If your lesson time is not finalized, what times do you generally have available?

Same as student #1
9am-12pm
12 - 2:30pm
2:30-3:45pm
3:45-5:15pm
5:15-6:45pm
6:45-8:15pm

Comments or preferences on your lesson time availability

I understand my registration is not complete until I have paid for the intro lesson of my choice. The Flourish office will contact me about scheduling my intro lesson if not already scheduled, and then will email me a proposal. I will click the link and enter my desired payment method to pay for the intro lesson. My payment method will be stored on file for future tuition payments. The intro lesson may be rescheduled with minimum 24 hours notice.*

I agree.

I have two days after my intro lesson to cancel my enrollment. If I do not cancel within 2 days, I will be automatically enrolled and the first full months payment will be charged to my payment method on file.*

I agree.

By registering for my intro lesson, I agree to the full terms and conditions of membership at Flourish Music Academy for ongoing lessons.*

Please note these are important details of your membership, payments, cancellations and withdrawals etc. that you will need to know and understand, so please review them carefully and let us know if you have any questions:

I agree to the terms and conditions

Comments

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