Registration


Please use the following form to register each child for classes. 
Please
call 269.753.5044 if you have any questions or concerns. I want every child to be a part of a class!!  

If you choose to pay by installments or need to make arrangements for the intial payment please tell me in the "Question/Comment" area of the registration form. Payment can be made by check or cash or Google Pay using the email address:  burghartr@gmail.com    Checks may be sent to:

Burghart Music Studio
16738 Hubbard Road
Marshall, MI  49069
 
If you do not wish to register on line, please contact us via phone, text or email and we will assist you in registration off line.

We will contact you after we receive your registration to confirm the availability and provide any additional  information.


Select Class:  

Preferred Day/Time:  (e.g. Tuesdays 09:30)
 
Parent's First Name:  
Parent's Last Name:  
Address Line 1:  
Address Line 2:  
City:  
State/Province:          
Zip/Postal Code:  
Email Address:  
Home Phone Number:   -   -  
Work Phone Number:   -   -  
Cell Phone Number:   -   -  
Alt. Contact Person:  
Alt. Contact Phone:   -   -  
Child's First Name:  
Child's Last Name:  
Child's Current Age:   months     years
Child's Birthdate:   (MM/DD/YYYY)  
List any allergies or medical issues of which the teacher should be aware:  
How did you hear about us?:  
Other:  
Question/Comment: