Online New-Student Registration
Applicant’s Name:
Parent/Guardian:
I am interested in:
Date of Birth: 
Age:
Age:Address:
City: State: Zip:
State: Zip:Home Phone:
Work Phone:
Cell Phone:
Billing Email Address:
*Please supply the email address checked most often and please add billing@MusicEdCenters.com to your address book to ensure proper reciept.
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School: Grade:
Grade: Teacher:
Type of Class:
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Briefly discuss the nature of the applicant’s disability, if applicable:
Describe your family’s Musical involvement:
What musical activities does the applicant currently participate in?
Do you have an instrument for practice at home?
Briefly describe the applicant’s verbal abilities:
How do you deal with problem behaviors at home or at school?
Are there any other special learning or environmental needs that we need to be aware of?
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Instrument(s) / Program of interest:
Teacher Preference:
Preferred Location:
Best Times for Lesson Scheduling:
The following times are unavailable for scheduling:
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How did you hear about Music Education Centers?
I give Music Education Centers at Uncle Andy’s Place permission to use photographic and/or video documentation of myself / my child for promotional and educational purposes including internet publishing, staff training and as an educational tool for other professionals.
Student Services
Music Education Centers offers a variety of Musical enrichment programs
Private Lessons
One-to-one instruction on many musical instruments taught by experienced and caring teaching professionals. Lesson programs are offered on almost any instrument and our program is designed for students of All Ages and Abilities. Private lessons are the gateway to joining a student ensemble or performing in a concert or recital.
Group Lessons / Ensembles
Lessons offered on Piano, Guitar and Percussion in an intimate small group setting. Socialization and cooperative learning is encouraged through lesson plans geared toward one particular instrument or groups of students will learn to perform songs together.
Ensembles will consist of Guitar, Bass, Keyboard, Drums, Voice and other auxillary instruments. Students will have the opportunity to perform at public events and our recitals.
Basic Songwriting
An introduction to the basic concepts of songwriting. Students will be exposed to various techniques of songwriting. Topics will include, melody, lyrics, structure and arrangement.
Other Services
Since All of our programs have developed at the reccommendation of our clients, we can tailor programs to fit your needs!
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