Adapted Learning Music Program Registration

Parent/ Guardian Information

Prefix

Prefix

Note: Bills will be sent electronically to your email address if provided.

Child Information

DD/MM/YYYY

Only if they have their own cell phone

Only if they have their own email address

Lesson Information

(why are you registering your child(ren) for adapted music lessons with DHMS?)

DD/MM/YYYY

Payment Information

Lesson costs will be set on an individual basis.

Additional Information (Optional)

Submit