Piano Playtime Locations*If Applicable1
Class Comments*Let us know if you have any questions regarding classes2
We tailor make your class to fit your needs, after you pre-register with this form we’ll talk regarding the learning style of your child so we make the best program possible. This form helps start the conversation by capturing basic information.3
First Name*Student's Name5
Last Name*Student's Name6
First Name 2nd Student*10
Last Name 2nd Student*11
Birthday - 2nd Student*mm-dd-yyyy12
Additional Student Information
Additional Student Info*Names & Birthdays of additional students15
Emergency Contact*Include Name, Number & Relation22
First Name*2nd Parent24
Last Name*2nd Parent26
Phone Number*2nd Parent27
How did you hear about us?*30
One-time registration fee is $40.00 ($10.00 for additional family members). Gymboree Play & Music registration fee is waived.
In-home lessons incure a monthly travel fee of $50-75 depending on location. There are no make-ups if a student cancels.
10% Family Discount for three or more enrollments.
For private or paired lessons, if your family chooses to participate, there is a nominal fee for our yearly Creations Concert performance. This is an inspiring opportunity for students to have their music performed by professional musicians. Payment options available.
For private or paired lessons, $40 one-time tuition fee for parents of Suzuki Piano Students. At the Parent Class, parents are taught the first 4 Suzuki songs, and are provided with tools for working with children at home.
For private or paired lessons, Suzuki Students must purchase Suzuki Piano Book/CD 1 ($19.99) and Nurtured by Love ($12.95) by Dr. Suzuki, available through DaVinci Center, or music stores.31
I understand that I am responsible for payment due and will give two weeks notice, in writing, by email, or phone call to DaVinci Center's Director if I decide to discontinue my child's participation in our classes. I understand that DaVinci Center does not prorate due to child's absence, severe weather cancellations, or other severe circumstances beyond the control of DaVinci Center. If an Instructor misses a lesson, a make up will be scheduled in a timely manner.
I understand that enrollment is not complete until a confirmation of registration email is received and I have been contacted by DaVinci Center for Creative Art to set up payment arrangements.
I hereby agree that all the provided information is correct and I am permitting my child(ren) to be registered in the above classes with DaVinci Center for Creative Arts.33
Please Check This Box to Agree to all of the above*34 Photo Release*Opt-In / Opt-out35
Questions & Comments*Please let us know if you have any questions or comments36
Digital Signature*Please type your name in this box in place of a written signature37
Thanks for registering with us!
In honor of your time and peace of mind, we have set up an Auto-Pay feature where your card is charged on the first of every month (prorated first month.) Your card will NOT be charged until after you have recieved a welcome letter explaining the details of the classes, billing, policies, etc. If you choose to pay by check, checks must arrive at the DaVinci Center mailing address by the first of each month (2205 West 136th Ave, #106-151, Broomfield, CO 80023.) Please do NOT mail to the DaVinci Center physical address nor leave checks at the preschools ($20 late fee after the 5th of each month). For Auto-Pay, please enter your payment information below. We will send you a link so you can change your payment information should the need arise. We appreciate you giving us a 1 month notice when disenrolling, to allow our billing team sufficient time to process the final payment. Thank you!
We will contact you soon regarding scheduling, and address any questions you may have. Look for our Welcome letter to come soon.
Credit Card #*We accept Visa and Mastercard39