2025-2026 Mikado Academy of Music Registration Form

Semester Rates:
30 minutes - $380 (entire semester) or five monthly payments of $76

45 minutes - $560 (entire semester) or five monthly payments of $112

*A 3% convenience fee will be added if you make an online payment.

Select Semester

Please select all that apply.

Fall 2025

Student's Name

Gender:

Please select one option.

Male Female

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Address

Phone

Student Grade Information:

Please select one option.

2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Adult

Name of School:

Church Name (If you attend a church, please give the name of the church below)

Area of Study

Please select one option.

Piano Violin Voice (waiting list)

Lesson Length Requested:

Please select one option.

30 Minute Weekly Lessons - 15 total lessons

How many years have you previously studied your instrument?

Please select one option.

0 (Beginner) 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 or more years

Notes: In this section you may indicate requested instructor. We will try to accommodate you the best we can.

Please select one option.

Noelle Hall (voice) - waiting list Kenny Infante (piano) Katie Kopp (piano) Dixie Money (piano) Mary Stephenson (violin) Micah Woodard (piano) No Preference

Enrollment Policies:

Non-Refundable Registration Fee: $25.00

Policies and Procedures:

Yes, I read and agree to the 2025-2026 enrollment policies.

Please select all that apply.

Yes

I understand that monthly tuition is part of a five-month payment plan (August–December and January–May) that covers the full semester fee, which includes 15 lessons. Tuition is not based on the number of lessons in a given month.

Please select all that apply.

Yes

I consent to the Academy of Music sending me monthly tuition statements via text message.

Please select one option.

Yes

Signature:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

2025-2026 Mikado Academy of Music Registration Form

Description

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