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FALL 2018 - ONLINE REGISTRATION 
Please use this form to register for Fall 2018 Private Lessons. You may register for both class and lessons on the same form. Check all boxes in Section II that apply.
Student Name
Birth Date
Age as 
of 1/1/18
Grade in 
Fall 2018
Student's Home Address
Street
City
State
Zip
PAYMENTS POLICIES 
(please read and complete certification statement)

• Payments may be made using Credit Card, Debit Card, or Checking Account transfer via PayPal. You will be directed to our online payment center once you have completed and submitted this form.

• The 2018 Fall Semester runs September 9 through December 18. Studio closed Sep 12, 17-18, Oct 8, Nov 19-24, and Dec 24-Jan 6.

• If you require an alternate payment method, please email studio.pineda@gmail.com or call the conservatory at 917.391.0842.

• YOUR CHILD IS NOT REGISTERED UNTIL WE RECEIVE $50 REGISTRATION FEE.
Student's Email
Parent/Guardian Name & Relation
Guardian's Cell:
Student's Cell:
Parent/Guardian Email
Home Phone:
I.  Student Information
II.  Payment Information
REFUND POLICIES 
(please read and complete certification statement)

• If paid in full, refund will be pro-rated based on the number of lessons completed by date of cancellation. 

​• For monthly payments, if canceled before the 15th of the month, refund will be pro-rated based on the number of lessons completed by date of cancellation. 

• For monthly payments, NO REFUNDS will be issued if canceled after the 15th of the month. 

Please email studio.pineda@gmail.com (subject line: "REFUNDS") for any further questions or clarification of our refund policy.
PLEASE PRINT A COPY OF THIS PAGE FOR YOUR RECORDS BEFORE YOU SUBMIT.  
Once you submit, you will be automatically directed to our payment page where you may pay using debit/credit card.
PAY IN FULL BY SEP 1 AND GET $25 OFF! (Discount automatically applied at check-out or on invoice.)
Enter initials here:
By initialing here, you certify that you have read and understand the Pineda Summer Conservatory payment & refund policies.
Preferred lesson days & time frame:
For PRIVATE LESSONS, would you like to receive a Paypal bill (VIA EMAIL | NO EXTRA FEE) each month so that you can pay via credit or debit card?
III.  Payment Options and Policies
Lesson length:
Pineda Conservatory of the Performing Arts a 501(c)(3) non-profit arts organization
PCPA @ FUMC, 1171 Terrill Road, Scotch Plains NJ   •   (908) 731-1377   •   studio.pineda@gmail.com.
Check box for appropriate class and/or voice lessons. You may register for both voice lessons and classes on the same form.
4 monthly payments
$136.25
$168.75
$233.75
In full ($25 discount applied!)      OR
$520
$650
$910                  
Length
30 mins
45 mins
1 hour  
Fall Semester 2018 Rates (does NOT include $50 Registration Fee*)
*Registration Fee: $50 non-refundable, per student, per semester. Due upon registration. Student is not registered until receipt of registration fee.
MaleFemale
PRIVATE WEEKLY LESSONS