Private Lesson Registration Form | Pakachoag Music School

2024-2025 School Year Private Lessons (PI)

Please enter information in all required fields and watch for a confirmation screen that your form has been successfully submitted.

Incomplete forms cannot be submitted and will not be received by the office.

Credit/Debit Card Deposit: a PayPal account is not required. You can skip account creation and check-out as a guest. If you have an account, you have the option to pay using PayPal Credit (0% interest if paid in 6 months).

Check Deposit: a check deposit must be received 5 business days before first lesson.

PI Tuition & Fee Information

PI Discounts & Financial Aid Information

PI Policies: Absences, Holidays, Withdrawals

Registration is not considered complete unless both the form and deposit have been received. A delayed submission and payment may result in starting lessons a week late and/or losing a hold in the teacher’s studio.

2024-2025 School Year Private Lessons (PI) Registration Form

Please complete and submit this form as part of registration.

"*" indicates required fields

Step 1 of 5

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Are you enrolling for...*

School Year Lessons

Preapproved Term (Confirmed by the Office in Advance)

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 of Study*

"Voice" for voice study.

Do you have an instrument for regular daily practice?*

Yes, I have an instrument in working condition.

No, but I am committed to purchasing/renting prior to starting lessons.

No, and I need help obtaining an instrument.

N/A, I am studying voice.

Assigned Teacher Name (if known)

Location Requested for Regular Lessons*

Please note that we are only offering lessons in Worcester and West Boylston.

Worcester

West Boylston

Either/Flexible

Desired Lesson Length*

The deposit amount includes the first 8 lessons and the once annual registration fee of $40. If registering sibling/s, billing will be adjusted after registration to reflect the $70 family registration fee.

30-minute Lessons ($400 Deposit)

45-minute Lessons ($552 Deposit)

60-minute Lessons ($704 Deposit)

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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

Chandler Magnet Elementary School

Elm Park Elementary School

Quinsigamond Elementary School

None of the Above

Student Grade (in or entering)*

N/A: The registering student is an adult.

Other

Student's Day School*

Please provide the name of the student's elementary, middle, or high school; or enter 'homeschooled'.

Scheduling

In-Person v. Online*

Online options and hybrid lesson models are available, according to teacher and student needs/interests. Please select 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.

In-Person Lessons Preferred

Online Lessons Preferred

Hybrid (Mix of In-Person & Online) Lessons Preferred

No Preference between In-Person and Online Lessons

Days that the Student is NOT Available*

Not Available on Mondays

Not Available on Tuesdays

Not Available on Wednesdays

Not Available on Thursdays

Not Available on Fridays

Not Available on Saturdays

Available ALL DAYS, Monday through Saturday

Is the student available before 3 PM?*

Please answer according to general availability on weekdays.

Yes: Always Available before 3 PM on Weekdays

Yes: Available before 3 PM on Some Weekdays

No: Not Available before 3 PM on Weekdays

Earliest Lesson START Time Possible*

Please allow a minimum range of 1.5 hours between start and end times. If enrolling two students, provide a minimum range of 2.5 hours.

Latest Lesson END Time Possible*

Please allow a minimum range of 1.5 hours between start and end times. If enrolling two students, provide a minimum range of 2.5 hours.

Schedule Details

Provide additional information about availability here, as needed.

Misc. Information

Use of 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.

We are able to use a stairwell.

We are NOT able to use a stairwell.

How did you find us / hear about us?*

Multiple choices are OK.

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*

While voluntary, 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/GUARDIAN 1 Ethnicity for Grant Reporting*

While voluntary, 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/Guardian 1 -or- Adult Student Name*

First Last

Parent/Guardian 1 -or- Adult Student Email*

Parent/Guardian 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 City State / Province / Region ZIP / Postal Code

Parent/Guardian 2 Name

First Last

Parent/Guardian 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/Guardian 2 Email

Deposit & Payment Information

Payment Method*

Please note that if paying by check, the check must be received 7 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. (via PayPal - no account required)

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

I have applied for Financial Aid. (invoice with revised deposit amount)

I am Faculty. (invoice with revised deposit amount)

Payment Plan Option*

Please select a payment plan option below. Further details are outlined in the Private Lesson Payment Plan Sample sheet found on the Tuition & Fees page. You can change your plan later, if desired.

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 kept on-file - no checks). Payments will be automatically charged during the first week of each month.

Support a Student in Need*

Thank you for considering a donation to our Music Matters program that supports tuition assistance for children/youth of low income.

Yes, please add a $15 donation to my final payment.

Yes, I'd like to contribute to the average cost of a class, a $25 gift.

Yes, I'd like to pay for an upcoming lesson, a $45 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?

The deposit amount remains the same. Discounts are applied retroactively to the remaining tuition balance due. The office will follow-up directly, if needed.

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

Group Class Opportunities

Consents

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 social media postings, print media, and the School website?

Yes

Other

Monthly Payment Plan: Consent to Monthly Credit/Debit Card Payments*

I permit Pakachoag Music School to charge payments to the credit/debit card on my School account during the first week of each month, according to the School's monthly payment plan schedule.

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 Pakachoag's private lesson (PI) program policies.

If paying with PayPal (vs. check) you may use any credit or debit card to make payment. A PAYPAL ACCOUNT NOT REQUIRED. Click "Pay with Debit or Credit Card" to checkout as a guest without creating an 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

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