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:
Visa
MasterCard
Amex
Number:
Exp: