Registration - Seacoast Academy of Music

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Student's Name
First Last
Age
Instrument or Class*
School
Grade
Preferred Teacher
Media Release*
- Yes
- No
Permission for SAM to photograph or audio/videotape classes, lessons and other activities without advance notice, and to publish royalty free in its print, audio and electronic promotions, including SAM's website. No personal information including names will ever be published.
Parent's Name
First Last
Email*
Billing Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone Number*
Alternate Phone Number
Gift Certificate
Indicate below in Additional Comments where you want the gift certificate mailed.
SAM 2017 Summer Registration
Private Lessons w/ Christine Petrucci
Private Piano lessons with Christine Petrucci
Private Lessons w/ Tj Wheeler
Private Piano lessons with Tj Wheeler
SAM Private Lessons
SAM Semi-Private Lessons
Special Events
Total
$0.00
Additional Comments
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Music Lessons For Everyone!