Levite Form

Levite School of Music
Registration Form

Dear Parent:

So we can process your information faster and more accurately,
please fill out this application as completely as possible.

Register each child separately that will be attending Levite School of Music.

We look forward to being a part of your children's education.

Thank you,

Director:
Karen Leigh

Parents... please enter the required * information below...

*Full Name:

*Address:

*City:

*State:

*Zip:

*Phone: (614) 555-5555

*Email:

Cell Phone

Please enter the required * information for your child below...

*Child's Full Name:

*Child's Age:

*Grade Entering:

*School Name:

Please enter any additional children below...

Child's Full Name:

Child's Age:

Grade Entering:

School Name:

Please enter your primary emergency contact information below...

*Emergency Contact's Full Name:

*Work Phone: (614) 555-5555

Levite School of Music Discipline Policy...

I agree that I will not hold the instructors of "Levite School of Music"
responsible in any way if my child(ren) incurs an injury while participating
in any activities during school hours.

I also agree to give the instructors permission to discipline my child(ren) and understand
that I will be notified if my child is behaving in a manner which would cause him/her
to be dismissed from further participation during the week.

* Yes, I agree, and I give my permission.

Fees...

$100.00 Per Child

Please remit your Check/Money Order to:

Levite School of Music
6011 Warbling Lane
Westerville, OH 43081

Thank You...

Thank you for taking the time to fill out this registration form.

If you're ready, click the "Submit" button.

We will process your application as fast as possible.

Someone will be in touch with you in a few days.

Thank you,

Director:
Karen Leigh

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