Infant-Grade 1 Classes – Selinsgrove

Please complete this form and mail your check (written to Susquehanna University) to Susquehanna University Music Preparatory Program, 514 University Avenue – Box RR, Selinsgrove, PA 17870 or pay online.

For private lesson and class availability, please call 570-372-4547.

Student Name

Age

Parent/Guardian(s)

Home Phone Number

Work Phone Number

Best Time of Day to Call

E-mail Address

Street Address

City

State

Zip Code

Relationship to Child

School Presently Attending

Grade

School Music Teacher

Have you studied in the program before? *

	I am a new student in the Preparatory Program
	I have studied in the Preparatory Program

Years of Study with Program

Most Recent Teacher

Selinsgrove Classes *

Sing, Move, Play, Create - Grades K-1 (Tuesday 6:30-7:15 p.m.) $104

Circle of Music Age: 4-5 yrs (pre-K only) (Tues 5:30-6 p.m.) $72

Circle of Music Age 2-3+ yrs. (Tues 10-10:30 a.m.) - $72

Circle of Music Age: 2-3+ yrs (Tues 4:30-5 p.m.) $72

Circle of Music Age: 2-3+ yrs (Tues 6-6:30 p.m.) $72

Circle of Music Age 0-24 mo. (Tues 9:30-10 a.m.) - $72

Circle of Music Age: 0-24 mo. (Tues 5-5:30 p.m.) $72

By completing this form, you agree to mail or pay online the requisite fee for the selected 8-session classes, and acknowledge that missed classes cannot be made up.

Note: A $10 discount on the total fee for families with two or more children enrolled in music classes for ages Infant through Grade 1.

Infant-Grade 1 Classes – Selinsgrove

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