Student Registration - Holy Names Music CenterHoly Names Music Center

Parent/Payor Name(required)

Email(required)

Phone Number(s)(required)

Best Time to Call

If new student, How did you hear about HNMC?

Complete Mailing Address (Street #, City, ST, Zip)(required)

Student Name(required)

Student Birthday(required)

Instructor(required)

Instrument(required)

Lesson Duration(required)

30 minute 45 minute 60 minute

Preferred Start Date

TUITION - School Year Commitment weekly lessons except for holidays. Monthly payment due in advance by 5th of month. Subject to late fee after 15th. Failure to pay may result in cancellation of lessons with reinstatement only upon payment in full. No refund or credit for lessons missed by the student. Lessons missed by the teacher will be made up or credited.

VARIABLE* - Invoiced at the end of month from teacher's time sheet. *Anything other than regular weekly lessons must be approved by teacher. Short notice cancellations may be considered unexcused.

See Rates & Policies link at bottom of page for full explanation of payment plans.

Tuition or Variable Payment Plan? (select one)(required)

Tuition Variable Summer

I would like to get the Payment in Full Discount (Entire Year tuition paid upfront by cash or check only).(required)

Yes No

HNMC offers instrument rental for string instruments. Our office or an HNMC teacher can assist you.

I need to rent an instrument. I am currently renting an instrument from HNMC

Do you want to use Autopay? (You may expect our office to call to set up)(required)

Yes (automatically charge my payment card for monthly lesson charges.) No

Do you give permission for photos of the student to be used by HNMC for promotional posts and/or fliers?(required)

Yes No

Electronic Signature of Person Responsible for Payment (Type Name) I have read and agree to the rates info and policies of HNMC(required)

Please check if interested:

I would like more information about volunteer opportunities.

Please make sure all (required) fields are completed before pressing 'Submit'

Our office will email confirmation of receipt & contact for AutoPay info if applicable within 1-2 business days.