Level Up Junior Enrollment Form

WE ARE SUPER EXCITED FOR YOU TO JOIN US IN LEVEL UP JUNIOR! IF YOU HAVE DISCUSSED A SUITABLE CLASS TIME WITH Allie, PLEASE FILL OUT THE FORM BELOW TO SECURE YOUR SPOT AND COMPLETE YOUR REGISTRATION.

Please note that this is a secure form that will be sent directly to Allie Friedman, the Level Up Junior Coordinator.

Student's Name

First Name

Last Name

Student's Date of Birth

YYYY

Student's Gender

Parent or Contact Name

If this enrollment is for an adult student, please just say "Adult Student".

First Name

Last Name

Email Address of Parent or Contact

If you are an adult student, please enter your email address here.

Phone Number of Parent or Contact

If you are an adult student, please enter your phone number here.

Credit Card Number

We accept Visa, Mastercard, and Discover credit cards. We also can process payment via ACH direct withdrawal from your checking account. Please note that there is a $4/month processing fee to use a credit card. There is no fee to use ACH. If you would like to switch to ACH after submitting this form to avoid the processing fee, please do so at any time during office hours.

Credit Card Expiration Date

MM/YY

Credit Card Security Code

This is the 3-digit code typically found on the back of your credit card.

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Location You Will Be Attending

Novi

Troy

Plymouth-Canton

West Bloomfield

Rochester Hills

Class Time

How did you hear about Expressions?

Level Up Junior Enrollment Form

WE ARE SUPER EXCITED FOR YOU TO JOIN US IN LEVEL UP JUNIOR! IF YOU HAVE DISCUSSED A SUITABLE CLASS TIME WITH Allie, PLEASE FILL OUT THE FORM BELOW TO SECURE YOUR SPOT AND COMPLETE YOUR REGISTRATION.

LOCATIONS:

INSTRUMENTS:

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