Private Lesson Registration Form | Pakachoag Music School

2023-2024 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.

Registration form and deposit must be received 3 business days before first lesson in order to confirm scheduling. A delayed submission and payment may result in starting lessons a week late and/or losing a hold in the teacher’s studio.

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.

Download/print PI Discounts & Financial Aid Info (5.19.2023) for the School Year 2023-2024 sample payment plan.

2023-2024 School Year Private Lessons OPEN Registration 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 for daily practice?*

Yes, I have an instrument at home.

No, but I will purchase/rent prior to starting lessons.

No, and I need assistance to obtain an instrument.

N/A, I'm a voice student.

Your Assigned Teacher Name (If Known)

For which location are you requesting assignment?*

Worcester

West Boylston

Either/Flexible

Desired Lesson Length*

The deposit amounts noted include the annual registration fee of $40. If you are registering more than one student, this fee will be adjusted in your account to reflect the $70 family registration fee.

30 minutes - $392 deposit

45 minutes - $544 deposit

60 minutes - $704 deposit

Is this student also enrolling in violin group classes?*

Our Suzuki program is on hold for the 2023-2024 school year. In lieu of Suzuki, we are offering violin group classes through the school year (bi-weekly / 16 classes total). Please note that your participation must be reviewed in advance with office before registering. Violin group class tuition is non-refundable.

Yes, I am enrolling in violin group classes ($160)

No.

Is the Student connected with...

African Community Education / ACE

Black Excellence Academy / BEA

Boys & Girls Club of Worcester

CENTRO

Elm Park Community School

Quinsigamond Elementary School

None of the Above

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

If not listed above, please note the name of the student's elementary/middle/high school. Or indicate 'none' or 'homeschooled'.

Scheduling

In-Person v. Online*

Online options and hybrid lesson models remain available, 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.

I prefer online lessons.

I prefer a combination (for flexibility).

I have no preference.

I prefer that best teacher match lead the decision.

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 indicate the earliest START 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*

Indicate 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.

Schedule Notes

If you need to provide additional information related to scheduling, please add a note 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?*

Multiple choices are fine.

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 Phone*

Send/Receive Texts?*

Yes, The School may send texts to this number.

No, I do not want to receive texts on this number.

Mailing Address*

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

Parent/Caregiver 2

First Last

Parent/Caregiver 2 Phone

Send/Receive Texts?

Yes, The School may send texts to this number.

No, I do not want to receive texts on this number.

Parent/Caregiver 2 Email

Deposit & Payment Information

Payment Method*

Please note that if paying by check, the check must be received 3 days in advance of the first lesson date. Registration is not confirmed until both the form and payment have been received.

I will pay by Credit/Debit Card. (PayPal checkout at the end of the form.)

I will pay by Check. (Please mail or deliver to the office within the next 2 days.)

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 October 1 through April 1 (credit/debit card on-file -- no checks). Payments will be automatically charged during the first week of each month.

Support a Student in Need Option*

Would you like to make a donation to the Music Matters program for children/youth of low income? Thank you.

Yes, please add a $10 donation to my final payment.

Yes, I'd like to contribute to the average cost of a class, a $20 gift.

Yes, I'd like to pay for an upcoming lesson, a $40 gift.

Yes, I'd like to sponsor a student -- please provide more information.

No, Thank You.

Do you anticipate qualifying for one or more of the following discounts?

Contact the office after submitting this form for verification. Please note that the deposit amount to register remains the same. Discounts are applied retroactively through the remaining tuition balance due.

Sibling Discount

Referral Discount

Active Military Discount

Partners in Music Discount

No, I do not anticipate qualifying for a tuition discount.

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

No ("Yes" response is required: please choose another Payment Plan option)

Hidden

IF YOU CHOSE: Traditional Payment Plan (5 Payments)

If you asked for a Traditional Payment Plan please indicate your acceptance of the following: If I miss submitting a payment by the due date, I authorize Pakachoag Music School to charge amount due to the credit or debit card on file. I agree to provide debit/credit information to the office prior to September 1st (or upon registration if after September 1st).

Yes

No (Late Fees will apply)

I do not have a credit or debit card (Late Fees will apply)

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*

Private lesson policies are found here: https://pakmusic.org/programs/music-lessons/lesson-policies/.

I have read, understand, 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, we will 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.

If paying with pay pal (vs. check/cash) you may use any credit or debit card to make payment. - NO PAYPAL ACCOUNT REQUIRED. Click until you see the gray button to pay without a PayPal account.

If paying by check, please make check payable to PakMusic and mail within 2 days of submitting this form. Your registration will be processed when payment is received.

Deposit Total

Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

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