musicwithmindy.com - Enrollment Forms-All
musicwithmindy.com - Music for Living...Music for Life

               Music Together®
       Parent/Child Class Enrollment Form
   ** please complete all areas and mail form, payment and any 
  coupon to: Mindy Arndt, Music With Mindy Learning Studio,                 125-5  N. Main St, Mooresville, NC 28115


Today's Date_________________________________________

Child's Name_______________________________Age:____________

Who will be bringing your child?**_________________________

Parent Name(s)_______________________________________

Mailing Address_______________________________________

City________________________State_____Zip code_________

Daytime Phone(s)________________________Text ok?_______

E-Mail_______________________________________________

Siblings (if attending)___________________________________

Additional Information concerning your child's health, behavior or development, including allergies:__________________________

____________________________________________________

**if different than parent


Semester:_______Fall________Winter________Spring 

Class Preference:___________________1st choice

                            ___________________2nd choice

Tuition Due: 1st Child************$185
                         Siblings: free
Discount, if any__________________

Total Payment Enclosed*********$__________Payable to :Mindy Arndt


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           SCHOOL YEAR ENROLLMENT
         Music With Mindy  Learning  Studio 
                     Private Lessons
 Contact Information  ✦ Business Agreement  ✦ Photo Release 
                                       2018 - 2019 
 
                              Contact Information
Student Name:________________________Date:___________

Parent(s)Name:_____________________________________

Address(include zip code)_____________________________

__________________________________________________

Email:_____________________________________________

Home Phone:_____________Cell:_____________text ok____ 

School:_____________________Grade:__________Age:____

                              Photo/Video Release

I,_____________________________, give permission to photograph and/or video my child __________________at MusicWithMindy Learning Studio during music lessons, camps or group activities. I also give permission for any images taken to be used on the studio bulletin boards, website, social media and printed promotional materials for the studio.

                    Business Agreement for lessons

Parent Please Read and Initial:

_____I have read the Private Lesson Guidelines located at musicwithmindy.com and agree to these terms:

_____I understand that it is important to encourage my child to practice each day and I will check the assignment book each week for any messages sent home.

_____I have read the policies regarding absences, and realize that it is my responsibility to request a make-up lesson when I call to cancel.   

_____I understand that the monthly tuition fees are due on the 1st day of each month, paying in advance for that month.  This year’s fee is $84.00/month.

_____I have read the policies regarding payment, and understand that I am to pay September and June payments during the 1st month of lessons.  The June payment will count as the 30-day notice if I stop lessons before the end of the school year.

_____I will contact Mindy in the event of any financial hardship or special circumstance regarding payment.

_____I know that the lesson schedule is on the website and that the next scheduled lesson is noted in my child’s assignment book.  Requests for changes may be noted there by myself or Mindy or via phone or email as needed.


Parent Signature:_________________________________

Date:_____________________


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       Music Together® Within Therapy 
           And Teen Adaptive Classes                                                             
         Information and Registration Form

                                                   FALL  2018

              NOW  OFFERING A TEEN CLASS!!!    
FRIDAY AFTERNOONS AFTER SCHOOL...ADULTS MAY ATTEND AS DESIRED.   A VARIETY OF MUSIC STYLES, RECORDING ARTISTS, AND MUSIC-MAKING EXPERIENCES.  COME JAM WITH US IN  "THE BACK ROOM ."                                  10 WEEK SESSION - $300 PER SESSION

 FALL SESSION BEGINS September 7, 2018
Class Dates:  9/14    9/21      9/28
                      10/12    10/19    10/26
                      11/8    11/9     11/30


*USE ENROLLMENT FORM BELOW

************************************************************************
    PRESCHOOL/SCHOOL-AGE  Adaptive CLASSES 

COME AND EXPERIENCE THE JOY OF MUSIC TOGETHER® CLASSES WITH YOUR CHILD WITH SPECIAL NEEDS.  CLASSES  WILL BE LED BY MINDY ARNDT, A  BOARD-CERTIFIED MUSIC THERAPIST WITH OVER 30 YEARS EXPERIENCE WITH CHILDREN AND ADULTS WITH SPECIAL NEEDS AND DISABILITIES.
      
MUSIC THERAPY PRINCIPLES AND MUSIC TOGETHER REPERTOIRE WILL BE COMBINED TO ADDRESS THE DEVELOPMENTAL NEEDS OF YOUR CHILD IN A SMALL GROUP  SETTING .    *****************************************************************************************************

THESE PARENT/CHILD CLASSES WILL MEET ONCE A WEEK FOR 10 WEEKS AND ARE  30 - 45  MINUTES LONG, DEPENDING ON THE NEEDS AND ABILITIES OF THE ENROLLED CHILDREN.  SIBLINGS AND ADDITIONAL ADULT FAMILY MEMBERS ARE WELCOME.  THERE WILL BE A MAXIMUM OF 4 FAMILIES PER CLASS.

Tuition: *****$300 - CHILD (see below
                                        for discount info)                  


classes are held at:  MUSIC WITH MINDY LEARNING STUDIO, 125 N. MAIN ST, MOORESVILLE, NC 28115


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                                  Music With Mindy Learning Studio
     MUSIC THERAPY GROUP ACTIVITY

               please complete and mail with payment to address below*

                            REGISTRATION FORM

CHILD'S NAME____________________________________DATE_______________

CHILD'S AGE__________TYPE(S) OF DISABILITY___________________________

_____________________________________________________________________

SCHOOL_______________________________________IEP?______YES______NO

PARENT'S NAME___________________________PHONE#_____________Text?___

Caregiver, if Attending with Child_________________________________________________________________

ADDRESS_______________________________________ZIP CODE_____________

E-MAIL ADDRESS______________________________________________________

NEW REGISTRANT____YES____NO     TOTAL AMOUNT DUE $________________

                                                     
PRESCHOOL AGE CLASS: Time Set as needed
TEEN CLASS:  FRIDAYS 3:30pm @ MOORESVILLE STUDIO                                                  
 ELEMENTARY AGE CLASS:  Time Set as needed                                                    

PLEASE INDICATE YOUR CLASS PREFERENCE_____________________________


ENROLLMENT AFTER START DATE MAY BE ELIGIBLE FOR  PRO-RATED DISCOUNT.
$20 DISCOUNT IF PAYMENT IS RECEIVED AT LEAST ONE WEEK PRIOR TO START DATE.  CREDIT TOWARDS NEXT SEMESTER MAY BE GIVEN IF YOU WITHDRAW BEFORE THE FIRST CLASS,  OR IN SPECIAL CIRCUMSTANCES. TRY A CLASS WITH NO OBLIGATION.


PARENT SIGNATURE___________________________________DATE____________ 

*CHECKS PAYABLE TO:  MINDY ARNDT
*MAIL TO:  MUSIC WITH MINDY LEARNING STUDIO, 125-5  N. MAIN ST, MOORESVILLE, NC 28115                                                             
  Questions?   704-677-2007         musicwithmindy@yahoo.com