Epitelo Music Academy
Teaching music to every child
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Class Registration
Please fill out the application below to register for any of our classes. If you are a current student, please only fill out "name" and ignore the rest of the basic information.
When you are done filling out the form and it is submitted, you will be taken to the Online Bill Pay where you can choose to pay online (if you choose not to, you may bring or mail a check to the studio).
Basic Information
Student Name
Birthday
Parents' Names
Address
Phone
Email
Does the student have any type of disability?
Yes
No
Unsure
If 'yes' or 'unsure,' please explain
If you are not a current student, are you interested in private lessons?
Yes
No
Maybe, send me more information
Class Information
Which class would you like to register for?
Mommy and Me Music 1 (6 - 18 mo.) Sept.
Mommy and Me Music 2 (18 - 36 mo.) Sept.
Autism Intro. to Music, Sept.
Percussion Class, Oct.
Silly Music Time!, Oct.
Autism Listening and Singing, Oct.
Mommy and Me Music 1, Nov.
Mommy and Me Music 2, Nov.
Autism Percussion Class, Dec.
Silly Music Time!, Dec.
This form is correct to the best of my knowledge
Yes
No
