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Rhythm Kids Registration

Rhythm Kids Registration

Thank you for your interest in registering for Rhythm Kids.

If you need assistance completing this form, please contact the office at 508-791-8159 or email info@pakmusic.org.

2022-2023 Rhythm Kids Registration Form

Please complete the form below and make payment via PayPal if possible. No PayPal account is required. You may use any credit or debit card. If you opt to pay by check, please mail the check within 2 days of submitting your form. Registration is not complete until payment is received.

"*" indicates required fields

Step 1 of 2

50%

Parent/Caregiver Name*

First Last

Parent/Caregiver Email*

Enter Email Confirm Email

Student 1 Name*

First Last

Date of Birth

MM slash DD slash YYYY

Hidden

Student 2 Name

First Last

Hidden

Date of Birth

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

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

Ethnicity for Grant Reporting - Primary Parent or Caregiver*

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes 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

Ethnicity for Grant Reporting - Student 1*

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes 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

Hidden

Ethnicity for Grant Reporting - Student 2 (Optional)

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes 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

Section Break

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

Other

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/

Consent*

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

Support a Student in Need Option*

Yes, please add a $10 donation to my payment

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

Yes, I'd like to pay for the average cost of two classes! $40

No thank you.

Rhythm Kids

Price:

Total

Section Break

Payment Choice*

Please indicate how you wish to make payment.

Credit/debit card

Check

Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

CAPTCHA

Phone

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

Contact Us

Phone (508) 791-8159
Office & Mailing Address Pakachoag Music School of Greater Worcester
10 Irving Street, Worcester, MA 01609
Email info@pakmusic.org

Home
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Impact
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Current Students

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© 2020 Pakachoag Music School of Greater Worcester: Worcester MA, Shrewsbury MA, Sterling MA, W. Boylston MA, Sturbridge MA, Auburn, MA | All Rights Reserved.