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Registration form

This form cannot be submitted online. Please print this form and mail or fax it to:

The Cleveland Music School Settlement 11125 Magnolia Drive Cleveland, Ohio 44106 Fax: (216) 421-5813

For more information, contact the Registrar.

Registration for		Music School  Early Childhood Arts New student  Returning student Current teacher:
Location		University Circle Satellite:
Billing name
Email
Address
City, state, ZIP		,
		Please include me on your mailing list. I would like to volunteer with the Friends of the Settlement.
Home phone
Work phone
Parent or adult student's employer(s)
Student name
Student birthdate		M D Y
Sex		Female  Male
		Individual lesson* - instrument: Tuition $ Class/ensemble: Day   Time Individual lesson* - instrument: Tuition $ Class/ensemble: Day   Time + $35.00 ($50.00)** non-refundable registration fee * Call Registrar at (216) 421-5806, ext. 109 for information on tuition and available lesson times. Prices listed in course listing are for one semester's tuition, but billing will reflect a full year's tuition. ** $35.00 Individual/$50.00 Family non-refundable registration fee per school year
Total amount due		$ Partial or full payment must accompany this form. Call for amount.
Payment method		I choose to make my payment by: Check payable to The Cleveland Music School Settlement (CMSS)  Money order VISA  MasterCard  Discover Account number: Expiration Date Authorized Signature: ______________________________ Amount $
(This form cannot be submitted online. Please mail or fax it to the address above.)

 


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