Thank you for registering for Pacific Conservatory Classes and/or Private Lessons. Your child is going to have a great experience! Please complete the contact and student information here. Make your selections from the drop-down menus. You may register one child in multiple programs by using Second and Third Child Registrations. You may print this form for your records. You will receive an email confirmation of your registration.
School Documents
Register for Pacific Conservatory
Classes & Private Lessons
Parent or Guardian Information:
Name:
Email Address:
Phone:
Address:
City/State/Zip:
How did you discover Pacific Conservatory?
First Child:
Child's First Name:
Child's Last Name:
Date of Birth:
Gender:
Allergies/Medications:
Special Needs:
Child's First Name:
Child's Last Name:
Date of Birth:
Gender:
Allergies/Medications:
Special Needs:
Second Child:
Third Child:
Child's First Name:
Child's Last Name:
Date of Birth:
Gender:
Allergies/Medications:
Special Needs:
Emergency Contacts:
Person's listed below are authorized to pick up my child.
Name Home Phone Work Phone Cell Phone Relationship
…where students of all ages reach their maximum artistic potential
in a friendly atmosphere guided by enthusiastic professionals.
1990 - 2012
Costa Mesa & Orange
(714) 545-1217
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PIANO
VOICE
GUITAR
DRUMS
VIOLIN
MUSIC THERAPY
PROGRAMS
Payment Information:
Exp
Name on Credit Card
Please Initial:
I have read and understand the Studio Policy regarding tuition payments. I authorize PC to debit from the account shown above the initial fee due on the account and on-going tuition rate.
I have read and understand the Studio Policy regarding 30-Day Notice to discontinue lessons. I understand the authority given to PC to charge tuition payments is to remain in full force and effect until PC has received 30-day written notification from me of its termination. I understand the the 30-day Notice to Discontinue must be received 30 days prior to the next charge date in order to stop the next automatic deduction. I understand that phone notifications and conversations with teachers do not constitute as notification. I understand that the 30-day Notice to Discontinue form must be turned in to the office and signed by the (adult) student or student's parent.
I have read and understand the Studio Policy regarding Make-up Lessons. Lessons cancelled within 48 hrs. of appointment are not eligible to be made-up. Make-up lessons are not guaranteed and all are give at the discretion of the private teacher. Group lesson students are welcome to attend other classes whena matching level class is available.
I have read and understand the Studio Policy regarding late payments and declined charges. A $45 bank fee will apply for any late payment due to declined credit or debit cards or other missed financial agreement.
I have read and understand that Pacific Conservatory operates on a 12-month school year calendar. I understand there are 43 weeks of lessons during the 12-month period and that tuition does not fluctuate with the number of weeks per month. Tuition is based on monthly, biannual or annual installments towards an annual tuition fee.
Electronic Signature Required (Parent/Guardian)
Date
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Schedule a
School visit
151 Kalmus Drive G-1 Costa Mesa, CA 92626 1311 E. Katella Avenue, Orange, CA 92867 714-545-1217 Admin@pacificconservatory.com
