RM_StatsStudent Type: * Adult Child Student's First Name *Student's Last Name *Student's Address Address Line 1 * Address Line 2 City * State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region * Country Zip * What is the preferred email address to receive HeartStrings communication? *Student Email (if different from preferred email entry for HeartStrings communication)Home PhoneCell Phone *Student's Birthdate *Student Gender *Parents' Names *Parent Address (skip if registering as an adult or same as above address) Address Line 1 * Address Line 2 City * State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region * Country Zip * Who will be the primary practice parent/contact? *Current musical groups or orchestras you'll be with this year:Grade: *Select an optionN/APre-KK123456789101112Post-secondarySchool Music Teacher:Session Selection(s)/Skill Level * Kids Singer/Songwriter - Level 1 - 30 min (37 lessons @ $50 ea. & 8 jam parties @ $50 ea. yearly) Kids Singer/Songwriter - Level 2 - 45 min (37 lessons @ $75 ea. & 8 jam parties @ $50 ea. yearly) Kids Singer/Songwriter - Level 3 - 60 min (37 lessons @ $100 ea. & 8 jam parties @ $50 ea. yearly) Singer/Songwriter for Adults (All levels) - 60 min (37 lessons yearly @ $100 ea.) Allergies/Medical RestrictionsHow did you hear about us?What is your monthly gross income? *Please explain why you are applying for a scholarship, listing any special circumstances that would give a complete picture of your family’s financial situation. *Excluding adults, list other dependents in household and their birthdays:Choose your preferred way to pay tuition (Following registration, an email will be sent detailing your rate and payment plan.) * Monthly auto debit on the 1st of each month Quarterly auto debit on 9/1, 12/1, 3/1, 6/1 Two auto debits per year on 9/1 and 3/1 One auto debit per year on 9/1 We offer $20 off yearly tuition for using a bank account to make tuition payments rather than a credit card! Are you interested in receiving this discount? Yes No Would you like to make your contact information available to other HeartStrings students/parents solely for the purpose of lesson swapping? * Yes No HeartStrings Parent's Guide & Policies (Click link at top of page to view) *I have read the full "HeartStrings Academy Parent Guide & Policies"I acceptPermission to take photographsI give HeartStrings Academy permission to use photographs taken during HeartStrings lessons and events for promotional purposes. Photos may be used in newspapers, marketing, website, social media, etc.I acceptMissed Lesson PolicyI understand the missed lesson policy and will refer to it when lessons are missed to determine allowed options.I acceptPayment Authorization *If I am awarded a scholarship application and choose to accept the award, I will provide an electronic payment method for payment of the reduced tuition amount. I authorize HeartStrings Academy to initiate electronic debit entries for payment of tuition drafts based on the payment option selected. I understand that I may quit at anytime, but there will be no refunds for auto debits already made.I accept Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
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HeartStrings Academy