Music Together Registration Form

Parent/Guardian Name*

First Last

Parent/Guardian Email*

Enter Email Confirm Email

Parent/Guardian Cell Phone*

Has your address changed?*

If you have been previously registered with Pakachoag Music School, has your address changed since you were last registered; or within the past 9 months?

Yes
No
NA - I'm new to Pakachoag

Address*

Street Address City State ZIP Code

Who will attend class with child?

If another adult will attend with the child (ie. grandparent, nanny, etc.), please contact the office with their contact info.

I will attend with child.
Another adult will attend with the child.

Name of Accompanying Adult

First Last

Email of Accompanying Adult

Student 1 name*

First Last

Student 1 Date of Birth*

Student 2 name

First Last

Student 2 Date of Birth*

Will this child be over 9 months on January 8th?*

Yes
No

Child #2

Please add a 1 in the quantity field if your child will be over 9 months on January 8th.

Price: $131.00

Student 3 name

First Last

Student 3 Date of Birth

Will this child be over 9 months on January 8th?*

Yes
No

Child #3

Please add a 1 in the quantity field if your child will be over 9 months on January 8th.

Price: $59.00

First Choice Class*

Each series of classes is $194 ($170 for online class). Please choose your first choice class below. We do our best to place everyone in their First Choice but on occasion we need to place families in their Second Choice class to balance family numbers and offer a wide-range of options. You will be contacted within two weeks of the class start date to let you know your class assignment and details.

Monday, 9:30 am Indoor, Sterling
Tuesday, 9:30 am Indoor W. Boylston
Wednesday, 9:30 am Indoor Auburn
Wednesday, 4:30 pm Indoor Auburn
Thursday, 9:30 am Indoor Auburn

Second Choice Class*

Please choose your SECOND choice class below. We do our best to place everyone in their First Choice but on occasion we need to place families in their Second Choice class to balance family numbers and offer a wide-range of options. You will be contacted within two weeks of the class start date to let you know your class assignment and details.

Monday, 9:30 am Indoor, Sterling
Tuesday, 9:30 am Indoor W. Boylston
Wednesday, 9:30 am Indoor Auburn
Wednesday, 4:30 pm Indoor Aubun
Thursday, 9:30 am Indoor Auburn

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First Choice Class*

Please confirm your desired class here. In the portal, you will also be asked to search for and then select your 1st choice class as part one of the registration process.

Tuesday, 9:30 am Indoor W. Boylston
Wednesday, 9:30 am Outdoor to Indoor Auburn
Wednesday, 4:30 pm Online
Thursday, 11:00 am Outdoor to Indoor Auburn

Babies Class Interest

For parents with babies under 9 months, we are seeking interest level to potentially add a Tuesdays, 9:30, 11:30 am or 12:30 pm Babies Online class with Linnea Lyerly. If interested, please check all that work for you. If we gain enough interest for a schedule a class, we will reach out and ask you if you'd like to switch to this class.

Select All
Yes, I'm interested in a 9:30 am class
Yes, I"m interested in an 11:30 am class
Yes, I'm interested in a 12:30 pm class

We are unable to provide any discounts for Babies classes, however we appreciate your advance registration which helps us plan.

Ethnicity for Grant Reporting - Primary Parent or Guardian*

Your response is appreciated and is helpful when reporting to grantors. Information is confidential and gathered for reporting purposes only.

Hispanic/Latino (any race)
Black/African American
White
American Indian or Alaska Native
Hawaiian or other Pacific Islander
Asian
Two or more races
Other
Prefer not to report

Ethnicity for Grant Reporting - Child One*

Your response is appreciated and is helpful when reporting to grantors. Information is confidential and gathered for reporting purposes only.

Hispanic/Latino (any race)
Black/African American
White
American Indian or Alaska Native
Hawaiian or other Pacific Islander
Asian
Two or more races
Other
Prefer not to report

How did you hear about us / find us?*

Word of Mouth (via a friend, relative, neighbor, another student, etc)
Facebook
Print Media (print ads, newspapers, calendar postings, etc)
Attended an event
Search Engine (google, bing, etc) / web site
Other Web Site
Teacher Referral
Brochure/Rack Card / flier (Library or other venues)
Other

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Support a Student In Need Option

Would you like to help a student in need by making a gift to our Financial Aid Fund? Thank you.

Yes, please add a $10 donation to my final payment.
Yes, I'd like to pay for an upcoming lesson, a $40 gift.
Yes, I'd like to contribute to the average cost of a class, a $20 gift.
No thank you.

Support a Student in Need Option*

Yes, please add a $10 donation to my final payment.
Yes, I'd like to pay for an upcoming lesson, a $40 gift.
Yes, I'd like to contribute to the average cost of a class, a $20 gift.
No thank you.

Receipt of Health Policies Acknowledgement*

Have you reviewed and do you agree to the Music Together policies, including specific COVID-19 Safety Policies? Policies can be found at: https://www.pakmusic.org/programs/music-together/policies/

I agree to COVID-19 Health Policies and other MT policies. I understand classes may need to be moved online if circumstances require.

Photo /Video Permission*

Do you give Pakachoag Music School permission for yourself and/or your child(ren) to be photographed and/or videotaped during school functions for school purposes and for such photos or videos to be used commercially by the school, including postings on the School web site.

Yes
No

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Payment Choice*

Credit/Debit Card
Check

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Discount Code

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Total Due

Please use the PayPal Checkout button below. You do not need a PayPal account. You will be taken to a window that includes a gray Pay with Credit or Debit Card button. If you are paying by check, you will click the blue Submit button and mail in your check to the 10 Irving St address written out to PakMusic. Thank you!

$0.00

Payment Method

Thank you for your interest in registering for Music Together with Pakachoag Music School.

2021-2022 Music Together Registration Form

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