NEIL McNAMARA MUSIC
(201) 358-6477
Unity Charter After School Music Program Grades 1-8
Tuesdays or Thursdays 2:30 – 4:30
½ Hr. Lessons after school taught in a small group setting
Lessons from Oct-May
25-week /Lesson program of study
Lessons available for: Piano, Guitar, Drums, Flute, Recorder, Trumpet, Violin and Saxophone
Rentals referred to The Music Shop, Boonton, NJ (Code 1913)
-------------------------------------------------------------------------------------------------------------------
NEIL McNAMARA MUSIC REGISTRATION FORM
Student Name___________________________________ Instrument ________________________
Grade/Room________________
Parent Name______________________________ Home # ( )______-_______ Cell ( )______-________
Address__________________________ City___________________ Zip __________
Parent Signature_________________________________ Email____________________________
Child in Aftercare? _______ Aftercare pickup time __________ Need Rental? ______
Please Check One | Monthly Fee | Registration Fee | Due with this Form | |
____ 1 Child | $ 58.00 | + | $ 15.00 | $ 73.00 |
____ 2 Children | $ 112.00 | + | $ 28.00 | $ 140.00 |
____ 3 Children | $ 165.00 | + | $ 40.00 | $ 205.00 |
PAYMENT: ☐ CHECK ☐ VISA ☐ MASTERCARD Card #___________________________ Exp. Date:_____________
Print Card Holder’s Name:___________________________ Signature_________________________ Date:___________
If my account becomes over 60 days past due, Neil McNamara is authorized to charge this credit card the past due amount.
CHARGE CREDIT CARD: ☐ 1st Month Only ☐ Auto Pay Monthly ☐ Full Payment (455.00)
Make checks payable to Neil McNamaara – 6 Glen Lane, Hillsdale, NJ 07642