HARMONY MUSIC SCHOOL /
Email: / / Website: / http://bmsmd.org / Phone: / (410) 781- 8011

REGISTRATION FORM FALL 2017

Student Information / Parents Information
Last Name / Parent 1 Name
First Name / Cell Phone
D.O.B. / Work Phone
Address / Email
City / Parent 2 Name
State / Cell Phone
Zip / Work Phone
Home Phone / Email

SEMESTER TUITION

September 9, 2017 – January 14, 2018

/ Check your selection / 1 payment / 1 payment / 2 payments
Before 8/15 / After 8/15 / 8/15 and 10/15
Private Lessons 30 min. / $465 / $475 / $240 ea, $480 Total
Private Lessons 45 min. / $615 / $625 / $315 ea, $630 Total
Private Lessons 60 min. / $765 / $775 / $390 ea, $780 Total

Preferred Instrument/Day/Time: ______

Option 1: / I am enclosing 1 complete payment with this form: / $______
Option 2: / I select 2 payments; the 2nd payment is due by October 15
Enclosed is the 1st payment: / $______
New Students Registration Fee / $ 35.00
TOTAL ENCLOSED: / $______

I consent and agree that the above student's name, picture, voice, or video may be used by Harmony Music School of Suhoy LLC for school publications, on the school Internet website, in school-related video productions, or for news and other publications. I hereby release Harmony Music School of Suhoy LLC and all of its officers, directors, and employees from all liability for personal injury, illness, or property damage occurring on or off Harmony Music School premises.

I have read, understand, and agree to all Harmony Music School Policies and Procedures published at http://bmsmd.org

Parent/Student Signature: ______Date:______/______/______

Make checks payable to: “SUHOY LLC” and mail to: P.O. Box 32039, Pikesville, MD 21282-2039

or drop in the black deposit box located inside the school lobby.