Enrollment Form

MagicMusic.com Enrollment Form

This 'https' form is SSL Encrypted for your privacy & security.

You can also use this form to purchase TRIAL LESSONS and GIFT CERTIFICATES.

This form may be used by existing Customers to securely update their new payment information or any other new information in our system. (Enrollment fees are only charged once per year, not each time this Enrollment Form is re-submitted.) Existing Customers may also use the 'Contact Us' Form located at the very top right of this website in order to update payment information or any other information into our system. The 'Contact Us' Form is also SSL Encrypted for your privacy and security.

Client Name * First Last
Student 1 Name * First Last
Student 1 DOB / MM / DD YYYY
Student 1 Gender
Student 1 Experience Level
Student 2 Name First Last
Student 2 DOB / MM / DD YYYY
Student 2 Gender
Student 2 Experience Level
Student 3 Name First Last
Student 3 DOB / MM / DD YYYY
Student 3 Gender
Student 3 Experience Level
Student 4 Name First Last
Student 4 DOB / MM / DD YYYY
Student 4 Gender
Student 4 Experience Level
Contact Method #1
Phone 1 * - (###) - ### ####
Contact Method # 2
Phone 2 - (###) - ### ####
Contact Method # 3
Phone 3 - (###) - ### ####
Email Address: (We do NOT accept @yahoo .com and @hotmail .com email addresses.) Please add our email address info@magicmusic.com into your email Contacts to reduce the chance that our emails get flagged as SPAM. Please constantly check your SPAM email Folder for MagicMusic.com email messages. *Also please note that all of our Office communications in our Music Program are handled via email communications, NOT via Telephone Calls and NOT via voice messages. You will let the Teacher know directly your preferred method of communication for the monthly scheduling with the Teacher. Email Address: *
Confirm Exact Same Email Address As Above: (We do NOT accept @yahoo .com and @hotmail .com email addresses.) Please add our email address info@magicmusic.com into your email Contacts to reduce the chance that our emails get flagged as SPAM. Please constantly check your SPAM email Folder for MagicMusic.com email messages. *Also please note that all of our Office communications in our Music Program are handled via email communications, NOT via Telephone Calls and NOT via voice messages. You will let the Teacher know directly your preferred method of communication for the monthly scheduling with the Teacher. Confirm Email Address: *
Best Times to Contact
Address Where The Lessons Will Be Held. This Can Be Home Or Office, etc.
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Preferred Lesson Location
Length of Weekly Lessons Desired?
As our Teachers are very popular and typically very booked, we ask that you please list all the days and times that you have available for Lessons (can be morning, afternoon, evening, and / or weekend hours). We may not be able to accommodate only one specific time window request. Weekday time slots occurring in the late afternoon / early evening {right after school and after work} hours are especially heavily booked. Please list as many days and times as possible (especially late weekday nights, and any weekend times):
How did you find out about us?
(If through a friend, relative, or acquaintance, please notate his/her name). *
Do you have your own instrument(s)?
Enter Type Of Instrument(s) For Lessons For Each Student, Followed By Name Of Each Student: *
Enter Name Of School(s) Attended By Each Student, And /Or Name Of Business(es) Each Student Works At, Followed By Name Of Each Student For Each Location:
Prefer to Begin / MM / DD YYYY
*Our system requires your payment guarantee in order to match you with a Teacher from our Music Program. Your payment card account will NOT be charged at all until after your first lesson is completed. The fee for Trial Lessons will be charged right after the Trial Lessons are completed. *Please read the Prices and the Lesson & Billing Policies located on the In-Home Lessons page of this website.
Credit / Debit / Payment Card Number: *
Expiration Date:
Please Enter Both the Month AND the Year: *
Security (Anti-Fraud) CVV Code. Required By Our Payment Processor.
3 digits on the BACK of Mastercard, Visa, Discover, Diners Club, & JCB.
4 digits on the FRONT of American Express.
Security CVV CODE: *
Name As Printed On Payment Card * First Last
Billing Address Officially Registered To Your Payment Card Account with Your Bank. *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Are There Any Special Needs, Or Learning Disabilities That The Teacher Needs To Be Aware Of?
Comments
I have read and agree to Magic Music's Prices & Policies located on the In Home Lessons page on this website. I understand that these policies are published and can be viewed online 24/7. I understand that if at any point in time I do not accept ALL of MagicMusic.com's published policies, myself / my household will not be enrolled in the MagicMusic .com Program. I understand that all Lessons are PRE PAID in advance, and that any Lessons cancelled by the Student are NON REFUNDABLE. * Yes, I Agree.
I have double-checked above to make sure that my payment card number, expiration date, and 3 digit CVV code from the back of my payment card (or 4 digits from the FRONT of American Express) are 100% correct. * Yes, I Have.