Enrollment

Please Select One *

New Student

Returning Student

Student's Name *

Birthdate *

School *

Grade *

Parent's Name *

Address *

Address

City

State/Province

Zip/Postal

Home Phone

Cell Phone *

Work Phone

Email Address *

Please choose the appropriate program: *

Preferred lesson day (1st Choice): *

Preferred lesson time (1st Choice): *

Preferred lesson day (2nd Choice):

Preferred lesson time (2nd Choice):

PREFERRED TUITION BILLING TERMS:

Billed Every 4 Weeks

Billed Every 8 Weeks

Billed By Semester

Do you have siblings that need to be scheduled together?

Yes

No

Tuition *

Payment is due on or before the first day of class. I understand that a $15 fee will be added to past due accounts.

Would you like to receive statements via email? *

Yes

No

Referred by:

Notes:

Photo Consent *

Yes, I agree to allow Zhen Music and Arts Institute to use images and likenesses of my child in the promotional materials, website, and social media of the school.

No, I do not agree to allow Zhen Music and Arts Institute to use images and likenesses of my child in the promotional materials, website, and social media of the school.

Release *

I hereby release Zhen Music and Arts Institute Instructors from any and all liability and responsibility in connection with such activities and hereby release all parties from liability by reason of any accident or of injury suffered by said child while engaged in such activities.

Parent's Signature *

Date *

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