Carey Music Academy Registration - 2026/2027

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

Student Name Student Name First Last
Student Age/Grade
Student DOB
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
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 require 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. Neither CMA Faculty nor William Carey University is responsible for your child’s safety outside of lessons. Be aware that the Thomas Fine Arts 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 require 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. Neither CMA Faculty nor William Carey University is responsible for your child’s safety outside of lessons. Be aware that the Thomas Fine Arts 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 $60 must be paid no later than August 10.

I understand that the annual registration fee of $60 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) - $70/month Music + Movement for Littles (ages 3-4) - $70/month Intro to Piano (ages 5-7) - $70/month Adult Piano Class - $90/month Private Lesson: 30-minutes/week Private Lesson: 45-minutes/week (not available with Undergraduate Teachers) Private Lesson: 60-minutes/week (available only with Teaching Artists)

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.
PRIVATE LESSONS ONLY
Student is registering for:

PRIVATE LESSONS ONLY Student is registering for: Piano Violin Voice

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.
PRIVATE LESSONS ONLY
Please indicate your preferred teacher level.

PRIVATE LESSONS ONLY Please indicate your preferred teacher level. Undergraduate Graduate Teaching Artist No Preference

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.
Is there anything we need to know about this student (learning styles or challenges, etc.)?
For students transferring to CMA from another teacher, please let us know how long your child has been in lessons previously.
Please sign below. By signing, you are agreeing to the terms and conditions of CMA's policies.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.