* = Mandatory Fields

Student Information

Student's First Name*

Student's Last Name*

Home Address*

Country

Street

City

Region

Postal Code

Birthday*

Email Address

Gender

Preferred Phone Number

Alternate Phone Number

Yes

No

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Parent/Guardian Phone Number*

Lesson/Class Information

Select one of the three choices for private lessons.*

Lesson Length*

Private Lessons (Check all that apply)

Instrument

Voice

Theory/Composition

Preferred Availability for Private Lessons

Weekdays (Monday - Friday)

Weekends (Saturday - Sunday)

Preferred Time of Day for Private Lesson

Morning

Afternoon

Evening

Classes

Mariachi de Pacific

Theory and Musicianship I (Grades 3 and 4)

Theory and Musicianship II (Grades 5 and 6)

Theory and Musicianship III (Grades 7 and 8)

Theory and Musicianship IV (Grades 9 to 12)

Theory and Musicianship IV (Ages 18 or older)

Music Background

Instrument*

Length of study*

Current school grade (if applicable)

After we receive your registration, we will contact you with further details.

Release Forms

Photo and Media Policy (read)

Assumption of Risk, Release of Claims, and Hold Harmless Agreement (read)

Emergency and Medical Contact Policy - (fill out and submit before the first class/lesson)

Acknowledgement (read, sign, and submit to PCMS@pacific.edu)

Please, read carefully the following documents and disclosures which make up the PCMS Manual of Procedures. To acknowledge that you have received and read these documents, please sign the Acknowledgment letter below and submit it along with your tuition payment, registration and Emergency and Medical form before the first class/lesson. If the Acknowledgement is not received, the student will not be able to participate in the PCMS programs.

Yes

Nonrefundable Application Fee

Pacific Community Music School Application

Nonrefundable Application Fee