Darien Arts Center Class Registration Form (Music)

Fill out the form below, print it, SIGN IT, and send it in with your payment. Mail it to:
  • The Darien Arts Center
  • 2 Renshaw Road
  • Darien, CT 06820
 or fax to 203-655-9470
If faxing, add credit card number and expiration date, otherwise leave credit card fields empty.
Name: Male Female
Age: Grade: Birth Date:
Address:
Town: Zip Code:
Parent's Name: Email:
Phone - Home: Work/ Cell: Emergency:
Instrument: Instructor: Day: Time:
Private Lessons
  15 Weeks Adjustment
(Pro-rated)		 Tuition  
Half hour lessons ($36 per lesson) $540 $ $  
10% sibling ($32.4 per lesson) $486 $ $  
45 Minute lessons ($46 per lesson) $690 $ $  
10% sibling ($41.4 per lesson) $621 $ $  
One hour lessons ($58 per lesson) $870 $ $  
Pro-rating? I will not be attending on: Registration Fee: $  
Day: Date: Donation to DAC: $  
Day: Date:   Total Enclosed: $  
Yes, I/we would like to contribute to the Darien Arts Center to help support the arts in Darien.
Artiste $50 Thespian $100 Virtuoso $250 Maestro $500 Other
Please make your checks payable to the DAC. All contributions are tax-deductible.
I understand all lessons must be paid for in advance whether taken or missed, If a lesson is cancelled due to teacher illness, etc., every effort will be made to make it up. Unfortunately we are unable to give make up classes for student absentees.
Signature:  
Credit Card: Number: Exp: