KCLC Music Lesson Scheduling Form

The Music Program at KCLC is dedicated to providing affordable and convenient after school private music instruction that introduces the joy of music theory, practice and proficiency in a variety of instruments.

If your child would like to participate in more than one lesson type, please complete a separate form. If you have multiple children to enroll, please complete one form per child.

Please note: Our registration process has changed. This form is only used to indicate your availability for scheduling purposes. In order to register, please visit our registration site at: kidscommunity.campbrainregistration.com

Participant Information

First Name

Last Name

Birth Date

Grade

Are you a... *

Returning student

New Student

Lesson Type: Select all that apply *

How much experience do you have with this instrument? *

I have never played this instrument before

I have been playing this instrument casually (on and off)

I have played this instrument seriously for 3+ months

I have played/had previous lessons 1+ years

Other Other

Schedule

Please note that drum lessons are only available on Fridays.

Violin and cello lessons are available on Mondays and Wednesdays.

Please check ALL lesson times that work with your schedule.

	3:15	3:45	4:15	4:45	5:15
Monday	3:15	3:45	4:15	4:45	5:15
Tuesday	3:15	3:45	4:15	4:45	5:15
Wednesday	3:15	3:45	4:15	4:45	5:15
Thursday	3:15	3:45	4:15	4:45	5:15

	12:15	12:45	1:15	1:45	2:15	2:45	3:15	3:45	4:15	4:45	5:15
Friday	12:15	12:45	1:15	1:45	2:15	2:45	3:15	3:45	4:15	4:45	5:15

Household / Adult Primary Contact

First Parent/Contact Name *

First Parent/Contact Phone *

First Parent/Contact Email Address *

Second Parent/Contact Name

Second Parent/Contact Phone

Second Email Address

Best way to contact you? *

Phone

Email

Text

This site is for scheduling information only. In order to complete registration, visit our Campbrain Site. *

I understand that in order to complete registration, I must register my child on Campbrain.

Music Program Policies and Information

I have read the KCLC Music Program Information Sheet and aware of all policies and procedures.

I understand that this class is offered by an outside instructor and that the certificate from the Office of Child Care for operation of a child care center does not apply. Therefore, the standards from the Rules for Certification of Child Care Centers may not apply. (Although we are required to have this on our forms, KCLC standard practices for safety and quality apply to all of our program activities and instructors).

Signature *

Date *