*indicates a required field

SECTION 1 - Contact Information

Parent/Guardian 1 *
(or student if over 18 and student is responsible for payment)
Address 1*
Address 2
Phone #1*
Phone #2
Phone #3
Parent/Guardian 2
Phone #1
Phone #2
Phone #3

SECTION 2 - Student Information

Student’s First Name*
Student’s Last Name*
Student’s birthdate* (is adult)
Student’s school and grade
Current Lesson/Class
Current Instructor
Current lesson day and time
Checkbox to keep current schedule
Preferred lesson length
Preferred schedule
My child is / I am enrolled in the following classes
Junior Strings Chamber Strings Chamber Ensemble
  Teen Vocal Ensemble Piano Partners Vocal Performance Workshop
  Rock Band Jazz Ensemble Suzuki Group Class
      Youth Chorus  
  Music Skills Pre-K Music Skills K-1 Music Skills Grades 2-3
  Theory Basics Music Theory Composition Workshop
Please indicate any changes or additions in the following text box:
Please check here only if you do not grant permission to use my/my child's image in promotional materials.

SECTION 3 - Payment Information

Cost for preregistered class is $250.
Name as it appears on credit card*
Is billing address same as contact address
Billing Address*
Billing Suite/Apt.
Billing City*
Billing State*
Billing Zip*
Credit Card Type*
Credit Card Number*
Card Security Code*
Card Expiration Date*

Your credit card account will be charged in three business days.

Click on“I agree to the Conservatory’s Registration and Tuition Payment policies”

If you have any questions or wish to discuss further, please contact Gary Mayer, Registrar, (914) 761-3900 X105,gary@musiced.org

See Our Policies Here
Music Conservatory of Westchester • 216 Central Avenue, White Plains, NY 10606
914.761.3900 • info@musiced.org
The Music Conservatory of Westchester is a 501(c)(3) not-for-profit organization.
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