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Noodles & Noggins Registration Form

Studio Information
Depending on what you sign up for, your lesson will meet once or twice a week for either 30, 45, or 60 minutes. If you are not sure, sign up for 30 minute lessons and we'll evaluate where you are and come up with a recommendation for you. Tuition is by month. Credit or Debit cards are the preferred payment but we also accept other forms of payment. Music books will be available for purchase at either the first or second class. Registration is limited and on a first- come-first-served basis. For woodwinds, the minimum age is 8. For Piano and Guitar, the minimum age is 5. For Musical Adventures, the minimum age is 3. A confirmation will be mailed to you with your lesson time once we receive your registration. To register by mail, by fax, or by person, simply print out this form and...

Mail or drop-by to: Noodles & Noggins
7145 Main St.
Clifton, VA 20124

Fax: 703-222-0308

Costs:
30 Minutes: $120/month
45 Minutes: $184/month
60 Minutes: $196/month
$25 non refundable registration fee will be added to your first month's tuition.

Fall Session Starts the Week of September 8th

1. Child's Information:

Name: Nickname: Age: (at class time)

Street Address:

City: State: Zip Code:

Is there another child your child would like to be grouped with? If Yes, tell us who:

2. Lesson Information:

Select the instrument, day, and time you are registering for. Hold down the CTRL (PC) or Command (Mac) key to make multiple selections.

Instrument/Day/Time:

Lesson Length:
30 Min
45 Min
60 Min

How old will your child be at the start of school? yrs old

3. Medical Information:

Child's Physician: Physician's Phone Number:

Does your child have allergies: (Check if yes. If yes, please provide details prior to first session.)

Are there any other care or treatment that we need to be aware of? (Check if yes. If yes, please provide details prior to first session.)

4. Parent/Guardian Information:

Name: Home Phone:

Work Phone: Cell Phone:

Address:

City: State: Zip: E-Mail Address:

5. Emergency Information:

Name: Home Phone:

Work Phone: Cell Phone:

Name: Home Phone:

Work Phone: Cell Phone:

6. Payment Information:

Credit Card: Credit Card Number: Expiration Date:

7. Waiver

Please Click I Accept after reading carefully:

In the event of injury or serious illness, I give permission for Noodles & Noggins staff to obtain medical treatment for my child. I understand that if my child needs to be transported to an emergency facility, that decision will be made by the emergency team responding to the call. PHOTOGRAPHIC RELEASE By click I Accept, I give permission to Noodles & Noggins to use photographs and videos of my child for publicity in order to increase awareness of Noodles & Noggins programs and in any and all publications and other media without limitation. LIABILITY RELEASE By clicking I Accept below I absolve Noodles & Noggins of any responsibility for any accident or injury to my child or caused by my child to others where neglect is not involved. Furthermore, I understand that Noodles & Noggins can only be responsible for my child during the days and times that he/she has been properly checked in and that Noodles & Noggins will not be responsible for my child when he/she is traveling to and from Noodles & Noggins.

I Accept I Do Not Accept