Student Name *

First Name

Last Name

Date of Birth

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number *

(###)

###

####

Emergency Phone Contact

(###)

###

####

Parents/Guardians

First Name

Last Name

Parents/Guardians

First Name

Last Name

How did you find out about Rivertown Music?Checkbox

Family/Friend

Local Business

Internet

Social Media

School

Teacher

e-Newsletter

Flyer/Ad

Rockland Parent Magazine

Nyack Villager Magazine

Current Student

Other

Were you referred by someone?

If yes, please let us know their name.

First Name

Last Name

Private Lessons

30 minute lesson $45 per lesson; Monthly Payment Plan $153; per semester $765

45 minute lesson $70 per lesson; Monthly Payment Plan $238; per semester $1190

60 minute lesson $85 per lesson; Monthly Payment Plan $289; per semester $1445

Private Lessons and Enrichment

30 minute lesson + 15 minute enrichment $70 per lesson; Monthly Payment Plan $238; per semester $1190

Buddy Lessons

Tuition is listed per student.

45 minute lesson $35 per lesson; Monthly Payment Plan $119; per semester $595

IF YOU'RE TAKING A BUDDY CLASS, PLEASE INDICATE YOUR BUDDY.

If not, skip to the next question.

First Name

Last Name

JOYFUL MUSIC PIANO (Ages 3-5)

45 minute class $30 per lesson; Monthly: $102; semester: $510

BEGINNER GROUP PIANO (Ages 4-6)

Thurs 3:00-3:45pm **4 student limit**

45 minute class $35 per lesson; Monthly Payment Plan $119; per semester $595

ACH Payments

Yes

Need more Information

YEAR IN FULL

$30/ $50 registration fee is waived

1st + 2nd Semester Due: 9/1

SEMESTER IN FULL

1st Semester Due: 9/1 + 2nd Semester Due: 2/1

MONTHLY PAYMENT PLAN

1st Semester :Payment Due: 9/1; 10/1; 11/1; 12/1; 1/1; 2nd Semester: 2/1; 3/1; 4/1; 5/1; 6/1

PHOTO WAIVER

Occasionally. Rivertown Music prints and publishes promotional materials. Please select appropriately:

Yes, I grant Rivertown Music to use my photos and/or my child's photos.

No, I do not grant Rivertown Music to use my photos and/or my child's photos.