We are excited to welcome you to Miller Music School! Please complete the registration form below.

Please read the Miller Music School Policies

Parent Name *
Parent Name
Student Name *
Student Name
Student Birthday *
Student Birthday
Phone *
Phone
Home Address
Home Address
Please indicate if you are interested in: Piano, Voice, or Violin.
Let us know your level of experience (absolute beginner, # of years in private/group lessons, etc...)
Private Lesson Schedule
Lessons are taught once per week. Please select the days that you prefer.
Music School Policies *
If you have read and accepted the terms listed in the Music School Policies, please check the box below
Authorization and Release *
By checking the box, the PARENT authorizes the MUSIC INSTRUCTOR to undertake use of photographs and/or videotapes of the CHILD for promotional or educational purposes by MUSIC INSTRUCTOR. The PARENT agrees to indemnify, release and hold harmless MUSIC INSTRUCTOR, his, her or its agents and representatives, from any claims or causes of action arising or related in any respect to the activity or the CHILD’S participation in such activity.