KD Music and Arts

KD Music Registration Form

Parent, legal guardian, or adult student: Please complete all information below.
Student Information

First, please share some basic information about your student.
Student’s Name
First NameLast Name
Male/Female
MF
Student Age
Child (Under 18)Adult (Over 18)
Student’s Birth Date
–Month –DayYearDate
Mailing Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code

Additional Information / Payment

Please Include Final Information Here
Do you have any additional information you’d like to provide about the student?
Whom shall we thank for referring you to us?
Drive-ByFlyerGoogle AdSearch EngineFriendOther
Please Enter Your Friend’s Name:
Please Initial Below.
Initial Here* The student above is healthy and able to participate in program activities.

Initial Here I give permission for my child to be photographed for KDMA publications, newspaper articles, and appropriate media. (Optional)
Registration fee is $50.00 per student and will cover registration for 1 academic year.
i.e. If you register in September 2024 for Fall semester 2024, registration will be valid through the end of Summer semester 2025.

Registration fee is nonrefundable.

Please select one registration option below for {studentsName}:

Please select to pay registration fee.

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KDMA Registration: 1 Full Academic YearRegistration fee: $50.00/ student, unlimited classes$50.00

Just InterestedI'm not sure I'd like to register, I'd like to just indicate my interest.$ Free
Quantity

Total
$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

KD Music Registration Form

Student Information

In-Depth Student Information

Parent / Guardian Information

Lesson and Learning Information

Emergency Contact Information

Additional Information / Payment

Please Initial Below.