Private Lesson Registration Form | Pakachoag Music School

2022-2023 School Year Lessons

Please complete the form below to register and submit your deposit for school-year private lessons. Use any major credit card or mail in a check.

A PayPal account is not required to make payment. You can choose to bypass account creation and check-out as a guest. If you have an account with PayPal, you have the option to pay using PayPal Credit (0% interest if paid in 6 months).

Please enter information in all required fields and watch for an on-screen confirmation that your form has been successfully submitted once completed.

Tuition and Fee information for lessons can be found on the Tuition & Fees Private Lessons sub page.

Summer lessons are scheduled and billed independently of school year. Find information on the Summer Session > Private Lessons web page here.

2022-2023 Sch Yr Private Lessons OPEN Reg Form

Please complete and submit this form as part of the registration process.

"*" indicates required fields

Step 1 of 5

20%

Are you enrolling for...*

School Year Lessons

Other Pre-Approved Arrangement

Student Information

Student Name*

First Last

Student Date of Birth*

For adult students, you are welcome to enter 01/01/1920 if you prefer not to be specific about age.

MM slash DD slash YYYY

Instrument for which you are enrolling*

Do you have a working instrument to use during lessons and at home for daily practice?*

Yes

No but I will purchase/rent prior to lessons

No and I need assistance to obtain an instrument

Voice student

Your Assigned Teacher Name (If Known)*

For which location are you requesting assignment?*

Worcester

W Boylston

Either/Flexible

Desired Length of Lesson*

30 minutes ($384 deposit)

45 minutes ($528 deposit)

60 minutes ($688 deposit)

Is this student also enrolling in the Suzuki violin or cello program?*

Please note that while you may be playing out of /using a Suzuki Method Book, participation in the program is based on participation in both a group class and a private lesson. The deposit amount is the same regardless of your group class schedule.

Yes ($160 deposit will be added to total)

Hidden

Number

Name of Student's School (for School Aged Students)

Please tell us the name of your day school - elementary, middle, Jr. High, High School or College. Or, please note 'none' or 'homeschooled'.

Scheduling

In-Person v. Online*

Online options and hybrid lesson models will remain available post-pandemic, according to teacher availability and student needs/interests. Please indicate your preference below. We cannot guarantee that all teachers are available for all options/models, but we will do our best to consider your preferences as part of the registration process.

I prefer in-person lessons over online lessons

I prefer online lessons over in-person

I prefer a combination (for flexibility)

I have no preference

I prefer that best teacher match lead the decision.

Do you have any questions about schedules as related to COVID-19?

Are there any days of the week that you/student are not available?*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

None; Available all days, Monday to Saturday

Is the student available prior to 3 pm?*

Please answer according to the student's general availability on weekdays.

Yes, always

Yes, sometimes

No.

Start Time Availability*

Please tell us the earliest possible time you can arrive for a lesson during the school year. If you do not yet know day of lesson, what is the earliest possible time you can usually arrive?

END Time Availability*

What is the latest possible end time you can be on hand during the school year. If you do not yet know the day of your lesson, please answer according to 'usually'. Please allow a minimum of 1.5 hours between start/end time; 2.5 hours minimum if enrolling two students.

Any Schedule Notes?

If you need to provide additional information related to scheduling, feel free to add notes here.

Misc. Information

Any disability that precludes using stairs?*

Does the accompanying adult, other attending family member(s), or scheduled student have any physical disability that might preclude using stairs? If this is an issue, we will do our best to provide an accessible lesson location.

Yes

Are you interested in Musicianship/Theory classes*

If a class is available for your age and approximate level, we will follow up with more information.

Yes

How did you find us / hear about us?*

Word of Mouth: Friend/Family Referral

Word of Mouth: School Teacher Referral

Online: Social Media (Facebook, Instagram, Etc.)

Online: Search Engine (Google, Bing, Etc.)

Print Media: Newspaper, Concert Program, Etc.

Print Media: Brochure, Postcard, Etc.

Attended a Pakachoag Performance or Event

Other

STUDENT Ethnicity for Grant Reporting*

We appreciate your reporting on this item which helps us report back to grantors around student reach and service. Information is used in aggregate only.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

Two or More Races

White

Prefer not to respond

Other

Contact Information

Parent/Caregiver 1 -or- Adult Student Name*

First Last

Parent/Caregiver 1 -or- Adult Student Email*

Parent/Caregiver 1 -or- Adult Student PRIMARY Phone*

Is your primary phone number...*

Cell / Mobile

Home

Work

Parent/Caregiver 1 -or- Adult Student Secondary Phone

Is your secondary phone number...

Cell / Mobile

Home

Work

Texting

Would you prefer receiving text messages?

Yes

Mailing Address*

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

Parent/Caregiver 1 -or- Adult Student Ethnicity for Grant Reporting*

We appreciate your reporting on this item which helps us report back to grantors around student reach and service. Information is used in aggregate only.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

Two or More Races

White

Prefer not to respond

Other

Parent/Caregiver 2

First Last

Parent/Caregiver 2 Phone

Is this phone number...

Cell / Mobile

Home

Work

Parent/Caregiver 2 Email

Deposit & Payment Information

Payment Method*

How would you like to pay?

I will pay by credit card or PayPal upon form completion

I will mail in check within next 2 days. Total due will be displayed on final page of form.

I have applied for Financial Aid. (We will email you an invoice with revised deposit amount.)

I am faculty and need a separate invoice.

Payment Plan Option*

Please sign up for one Payment Plan option by choosing from the Options below. For further details, the Options are outlined in the Private Lesson Payment Plan Sample sheet found on the Tuition & Fees page. You can change your Plan later if you like.

Option A: Full Payment (5% discount) | deposit now + remaining balance due no later than Sept 30 (cash/check/credit/debit/PayPal accepted)

Option B: Monthly Auto-Pay | Deposit now + 7 equal payments through April 1st - credit/debit/PayPal only (no checks)

Support a Student in Need Option*

Would you like to help a student in need by making a gift to our Financial Aid Fund? Check below your choice and we'll add your gift amount to your next payment. 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 - $20 gift.

Yes - I'd like to sponsor a student. Please provide more info.

No thank you - not at this time.

Additional Information Request

Please let us know if you would like additional information regarding...

Financial Aid

Payment Plan Options

Other

Consents

IF YOU CHOSE: Monthly Payment Plan

If you asked for a Monthly Payment Plan please indicate your acceptance of the following: I allow Pakachoag Music School to charge payments to the credit or debit card on file with the office during the first week of each month. Cards will be charged in keeping with the School's monthly payment plan schedule.

Yes, I understand my debit/credit card will be charged on a monthly bais.

No, I do not authorize auto charges. NOTE: Please contact the office within a few days. We'll need to discuss payment options before lessons begin.

Photo/Video Consent*

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

Other

Please review our lesson policies, including student/faculty make-up information, at this link prior to completing registration, and confirm your acceptance below. Lesson Policies

Lesson Policies Consent*

I have read and agree to the private lesson program policies.

As long as COVID-19 remains a public health concern (as according to CDC and/or local guidelines), once we have placed you with a teacher, depending on the status of COVID, we will or may send one more consent form which is a release of liability connected to in-person visits to the school and COVID-19. We'll ask for that form to be signed and submitted via email in advance of confirming an in-person lesson start date.

Deposit Total

If paying by check, please make check payable to PakMusic and mail within 2 days of submitting this form. If paying by credit card, click the PayPal button and you will be able to use any credit debit card to make payment - NO PAYPAL ACCOUNT REQUIRED

Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.