Student Information (Family)
Use this form if you are interested in a free trial for a child, another student or more than 1 student together.
If you are interested in a free trial for yourself only, please use the
Independent Information Form
.
Click the link below
https://spacecityschoolofmusic.teachworks.com/form/independent-student-
registration
Leaving a Credit Card or Debit Card will include a 5% discount.
If you wish not to leave a card on file,
please register with the link below
https://spacecityschoolofmusic.teachworks.com/form/student-registration-family-no-cc
Parent's First Name
Parent's Last Name
Email
Confirm Email
Mobile Phone
Home Phone
Address
Address Line 2
City
State
Zip
Credit Card Details
(Payment is processed before the first lesson of the month, you will receive an itemized invoice 5 days before payment )
Preferred Method Of Payment (Card will be charged if not paid by due date)
Select
Autopay
In Person
Please click the link below and carefully read through the SCSM lesson policies below. When you are finished, please agree by clicking the check box below.
https://docs.google.com/document/d/1xX8ET0qJZh6d18vb3JSBkKAsHhzERI8y3FM19Y0jbKI/edit?usp=sharing
I have Read and Agree to the Lesson Policies
Did someone refer you to us?
How did you hear about us?
Select
Yard Sign
Online Ad
Facebook/Social Media
Google
Website
Drive By
Word of Mouth
Other
Student
First Name
Last Name
Birth Date
Start Date
Grade
Briefly describe some of your musical goals.
Student's Favorite Band/Artist
Instrument(s) Of Choice
Guitar
Drums
Vocals
Piano/Keys
Ukulele
Bass Guitar
Program(s) Of Choice
Group Instruction
Private Instruction
Hybrid Instruction
Coupon Code:
Remove
Add Fields for Additional Student
Submit
