Student Name *
Student Name
Parent/Guardian
Parent/Guardian
Applicable only to students under the age of 18.
Phone *
Phone
Best phone number to contact the customer.
Please choose a desired instrument of study and lesson length.
Lesson Location *
Please choose the best location for your lesson. Students not enrolled at Memorial or Brazoswood High Schools are not eligible to receive lessons at those locations. Students enrolled at either Lake Jackson Intermediate or Spring Branch Middle Schools are welcome to schedule their lesson time after school at their in district high school being either Brazoswood or Memorial High School.
Please provide several. Lessons are available during lunches and off periods as well.
For students enrolled in choir at Brazoswood HS, Memorial HS, and Lake Jackson Intermediate, please enter their choir period. If not applicable, type "n/a."
Name on Bank Account or Credit/Debit Card *
Name on Bank Account or Credit/Debit Card
Please provide the name listed on the bank account or credit/debit card you wish to use for payment.
Address *
Address
Please provide the address associated with your account payment.
Please provide either the routing number of the bank account to be debited or the credit/debit card number you wish to use for your monthly payments.
Please enter numbers w/out symbols (hyphens & backslashes). If you expiration date is 10/2016, type "1016" into the field.
If not using a bank routing number, please provide the three digit security code found on the back of your credit/debit card.
As the legal guardian of the student listed on this registration form, I hereby acknowledge and agree, by checking this box, to fully abide by the terms and conditions outlined within the "Tuition & Policies" page of the Bayou City School of Music webiste. Failure to abide by these policies will result in the termination of lessons and no refund for a given month of lessons. PLEASE MAKE SURE TO CAREFULLY READ "Tuition & Policies" before checking this box. *
SIGNATURE *
SIGNATURE
Please type name as it would appear on a signature.