Registration Kindermusik

(914) 833-8941 Phone

(914) 833-3574 Fax

Larchmont Music Academy

2089 Boston Post Rd.

Larchmont, NY 10538

Kindermusik Registration Form

Name of Student: _____________________________________________

Street Address: ______________________________________________

City: ___________________________ State: ______ ZIP: __________

Phone: __________________________ Date of Birth: _______________

Parent's Name: _______________________________________________

Emergency Phone: _____________________Cell Phone:____________________

Important Medical Information: __________________________________

Class Name and Time: ________________________ Email Address________________________________________

Starting Date: ___________Summer only check one - Session 1______________Session 2____________________

Cancellation and Refund Policy

Tuition 1: __________________

Tuition 2: __________________

Total: _____________________

Payment: ___________________

I have read and understood the

cancellation and refund policy:

Signature: ________________________________

Cancellations and make-up lessons: Two classes per semester may be made up. All cancellations must be made 24 hours in advance in order to be made up. If a cancellation is made without 24-hour notice no make-up will be given, except in cases of sudden illness or emergency. Two opportunities will be offered for each make-up. If both are refused the lesson will be considered made up.

Refunds and Policies: Registration fees are non-refundable. A Larchmont Music Academy credit will be applied to any withdrawal from individual instruction or classes until the fourth week of the semester on a prorated basis. However, no credit will be issued after the fourth week of classes, except in cases of prolonged illness. Tuition is fully refunded if the student withdraws before the first class or lesson. There are no refunds after the first class or lesson. My child's picture may be used for publicity purposes. LMA is not responsible for lost or stolen property.

Office Use

QB CL L T R