After School 2018-19 General Registration Application
Thank you for applying to Project Grace's After School Music Program!! Classes run once a week at The Bethany Center, 10 Paton Street.

Project Grace is open to children in Grades 1 through 9. Some classes may have designations based on age or ability.

Questions may be sent to

Please fill out all fields accurately and thoroughly. This information is required for participation in Project Grace's after school music program.
Child's Name *
Your answer
Child's Age / Birthday *
Your answer
Child's School *
Your answer
Child's Grade (2018-19 school year *
Other musical activities in which the Child participates:
Your answer
Allergies, Behavioral Issues, Medical Concerns/Diagnoses:
Your answer
Parent / Guardian Name(s) *
Your answer
Telephone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Telephone Number *
Your answer
Home Address *
Your answer
E-Mail Address *
Your answer
Tuition Payment - $150 per child (January to June) *
Please note: due to availability of PG library instruments, size of child versus size of instrument, class offerings etc. we cannot guarantee that we will be able to accept your child on their instrument of choice. We will make every attempt to find a suitable instrument/class for your child.

By providing your own instrument, you enable another child (who is unable to purchase/rent/borrow their own instrument) a place in our program by freeing up one of PG's library instruments.

We schedule on class per instrument / skill level each week. The schedule is fixed and cannot be adjusted for individual students. You will receive information on the schedule by email, upon confirmation of registration.

Instrument, First Choice: *
I will provide an instrument for my child: *
Personality Rights Waiver
Request for permission to use, copy or display child's photograph or video recorded image to promote PROJECT GRACE events & advertisements on websites, news releases, pamphlets, brochures or other: *
Unfortunately Project Grace is unable to offer make ups for missed group lessons.

Registration will be confirmed once payment is received.

I agree that the information contained within this application is accurate, and I understand that I will be contacted via email in the coming days/weeks to confirm registration in Project Grace's 2018-19 After School Music Program.

Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.