Carey Music Academy Registration Form 2025/2026

*For families with multiple children registering, please fill out a separate form for each child.

Student Name Student Name First Last
Student Age/Grade
Instrument
Parent Name Parent Name First Last
Parent Email
Parent Phone Parent Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
If you have a preferred lesson day and/or time that works best for your family, please include that here. We will do our best to accomodate your preferences. If no teacher is available during your preferred time request, you will be placed on a waiting list and contacted when a teacher is available.
My child has no medical conditions that will keep him/her from participating in the full range of activities planned for the semester. By applying for lessons, I grant permission to the instructor/faculty/staff to seek medical treatment in the event of medical emergency and act according to their best judgment regarding medical attention. My child is covered under my health insurance, and I do hereby release and discharge CMA or any related instructor or staff member from any claims, demands, and actions on account of any injury to my child that may occur en route or during lessons.

My child has no medical conditions that will keep him/her from participating in the full range of activities planned for the semester. By applying for lessons, I grant permission to the instructor/faculty/staff to seek medical treatment in the event of medical emergency and act according to their best judgment regarding medical attention. My child is covered under my health insurance, and I do hereby release and discharge CMA or any related instructor or staff member from any claims, demands, and actions on account of any injury to my child that may occur en route or during lessons. I agree. I do not agree.
For students under the age of 15, we request that a parent or caregiver be present during lessons and while your child is practicing in the music building for security reasons and protection of your child. CMA Faculty cannot be responsible for your child’s safety outside of lessons. Be aware that the music building is a public location where numerous individuals have access to the practice rooms and hallway. Your child’s safety is very important!

For students under the age of 15, we request that a parent or caregiver be present during lessons and while your child is practicing in the music building for security reasons and protection of your child. CMA Faculty cannot be responsible for your child’s safety outside of lessons. Be aware that the music building is a public location where numerous individuals have access to the practice rooms and hallway. Your child’s safety is very important! I agree. I do not agree.
I have read and agree to all CMA policies.

I have read and agree to all CMA policies. Yes No
I understand that the annual registration fee of $50 must be paid no later than August 10.

I understand that the annual registration fee of $50 must be paid no later than August 10. Yes No
Student is interested in:

Student is interested in: Music + Movement for Babies (ages 0-2) - $60/month Music + Movement for Littles (ages 3-4) - $60/month Intro to Piano (ages 5-8) - $60/month Adult Piano Class - $90/month Private Lesson: 30-minute/week Private Lesson: 45-minute/week Private Lesson: 60-minute/week

Private lesson fees depend on the level of the teacher & the length of the lesson. Please refer to price list & CMA policies for exact prices.
Student is interested in the following festivals/activities:
(Note: Students must have at least one year of lessons to participate in NFMC & MTNA events.)

Student is interested in the following festivals/activities: (Note: Students must have at least one year of lessons to participate in NFMC & MTNA events.) Studio Recitals CMA Outreach Recitals HMTL Recitals NFMC Festivals MTNA Events (festivals, competitions, etc.) MS Baptist Keyboard Festival Student is interested in all. Student prefers not to participate. Other
Is there anything we need to know about this student (learning styles or challenges, previous lessons, etc.)?
Please sign below.

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Full Name

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