CHT Class Registration
2017 New Enrollment/Renewal
First and Last Name
Accordion, Tuesdays 6:00-8:00pm
Bajo Sexto, Wednesdays 6:00-8:00pm
Accordion, Saturdays 10:30am-2:30pm
What is your student status?
Primary Phone Number
Emergency Contact Name
Emergency Contact Phone
Date of Birth
Do you own an instrument?
I own my bajo/accordion
I may need to borrow an accordion/bajo during class
Demographic Information, check all that apply (Optional)
Household income under $30,000
Household income between $30,000 - $50,000
Household income between $50,000 - $100,000
Household income above $100,000
Current college student
Grade student (K-12)
Payments are due on the first class of the month. If you are unable to make payment, please let us know.
Select Payment Plan
3-month option $120 *Save $15
6-month option $225 *Save $45
Pay Online: Send payment today via our fee-free PayPal Giving Fund link. A PayPal account is not required.
Cash or check on the first class day of the month.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service