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Registration for '24-'25 Private/Semi-Private Music Lessons with

Anamaria De La Cruz, MA

Student's First name

Student's Last name

Billing Address

Primary Phone

Emergency Contact Phone Number

Student's Date of Birth

Month

Day

Year

Select Your Class

Select Your Desired Class Time (Please note that your instructor will contact you if your desired time is no longer available)

I have read to and agree to the Waiver & Release

I have read and agree to all class policies.

Your (Adult) Printed Name

Signature (Adult/Parent/Guardian)

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Date

Month

Day

Year

I consent to me/my student appearing in promotional materials (print/media/online) regarding the music class

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