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Online Registration Form * Required Fields (Due to spam issues, no symbols or punctuation are permitted.) * Student Name: Date of Birth: (No dashes or symbols) Parent Name: Street Address:  Apt / Suite City / State / Zip: * Home Phone: (No dashes or symbols) Cell Phone: (No dashes or symbols) Work Phone: (No dashes or symbols) Email: School:   Grade:  Lesson Duration: --Select One-- 30 Minutes 45 Minutes 60 Minutes Preferred Lesson Day/Time: Preferred Location: -- Main Branch - O'Bryonville -- --Branch Locations (Vocal Only)--    Joy Community Church    Milford United Methodist Church --Satellite Locations (Vocal Only)--    Anderson High School    East Central High School, IN    Glen Este High School    Indian Hill High School    Lakota East High School    Lakota Freshman School    Lakota West High School    Loveland Junior High    Mason High School    Mercy Montessori (Piano Only)    Nagel Middle School    McNicholas High School    Milford High School    New Richmond High School    Sycamore Junior High    Taylor High School    Turpin High School    Winton High School    Wyoming Middle School    Wyoming High School Method (violin & piano only): --Select One-- Traditional Suzuki (More Information) Lesson Type: Instrument (please specify)   Voice   Drama Beginning Quarter: Fall Winter Spring Summer I have read and understand MAC's Waiver Liability Statement * I have read and understand MAC's Policies * By checking this box, I certify that I am 18 years of age or older. *