Rhythm Kids Registration Page

Parent/Guardian 1*

First Last

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian 1 Email*

Parent/Guardian 1 Phone Number*

Phone Type*

Is this phone number...

Cell / Mobile
Home
Work

Student 1 Name*

First Last

Student 1 Date of Birth*

Student 2 Name

First Last

Student 2 Date of Birth

Parent/Guardian 2

First Last

Parent/Guardian 2 Email

Parent/Guardian Secondary - Phone

Phone Type*

Is this phone number...

Cell / Mobile
Home
Work

Ethnicity for Grant Reporting Purposes: Primary Parent*

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes only.

Hispanic/Latino (any race)
Black / African American
White
Asian
Mixed Race
Other
Prefer not to answer

Ethnicity for Grant Reporting Purposes: Child 1*

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes only.

Hispanic/Latino (any race)
Black / African American
White
Asian
Mixed Race
Other
Prefer not to answer

Ethnicity for Grant Reporting Purposes: Parent 2 (Optional)

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes only.

Hispanic/Latino (any race)
Black / African American
White
Asian
Mixed Race
Other
Prefer not to answer

Ethnicity for Grant Reporting Purposes: Child 2 (Optional)

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes only.

Hispanic/Latino (any race)
Black / African American
White
Asian
Mixed Race
Other
Prefer not to answer

Photo/Video Consent*

Do you give Pakachoag Music School permission for yourself and/or your child(ren) to be photographed and/or videotaped during school functions for school purposes and for such photos or videos to be used commercially by the school, including postings on the School web site.

Yes
No

Please review our Registration policies at this link prior to submitting this form, and confirm your acceptance below. Registration Policies

Consent*

I agree to the school policies.

Tuition*

Please confirm here the tuition amount you will submit by checking the appropriate box. These rates are discounted assuming payment by check or cash. Please mail your check within two days.

1st child - $186.00
2nd child - $126.00

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Register & Pay With Credit Card

Register & Mail In Check

LF: RK Web Reg Form, with Check To Be Mailed

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