Summer Semester
July 1 - August 31
(register and begin anytime)

Choose from 4 attractive Study Courses   Equipment ownership not necessary
FREE lesson for each student referral   FREE Practice Time
School Hours: M-F 10 am - 8 pm  Sat 10-6; Sun 10-5

*Hobby curriculum (no reading or practice requirements) 
*Pro curriculum (reading and practice requirements)

Print & Complete this form and send with one month's tuition plus a $25 registration fee (per child)
Check or MO (make out to NDA): Send to NDA, PO Box 626, N. Bellmore NY 11710
Credit Cards: We accept Visa, Mastercard, American Express & Discover
Fax: 516-735-2995  Mail: NDA, PO Box 626, N. Bellmore NY 11710

This application is for: ___Drums  ___Piano/Keyboard  ___Guitar  ___Timpani
____Xylophone  ___Vibes  ____Marimba  ___Conga  ____Concert Bells
Monthly Tuition: $95 school  /  $140 home  
Second Family Member: $85/$130   Third Family Member:  $75/$120

Study Course A:  Weekly lessons for both months
I am available:
 1-Day:________ From:____to____
2-Day:________From:____to____
Study Course B: Weekly lessons for one month:__________Tuition: same as above
Study Course C: Two lessons each month on (dates) _________________ Tuition: half of above
Study Course D:  One lesson each month on (dates) _____________ Tuition: quarter of above

Curriculum: ___Hobbyist  ____Professional
Length:    ___Half Hour  ___Hour (double monthly tuition)
Frequency:   ___Weekly  ____ Every other week (halve the monthly tuition)
Location: ____At Our School    ____In Your Home
Student Background:  ____Beginner  ____Intermediate  ____Advanced
____Right Handed    _____Left Handed
Instructor Request: (optional/subject to availability) _________________

Date: ______  I was referred by _____________
Name__________________________________
Address_______________ City______________
State_________ Zip___________ DOB________
Credit Card_______________________________
Exp_______  Name on Card__________________
Home # ______________  Cell # ______________

Student Agreement: I've read and understand the School Guidelines brochure and/or reviewed them online at lidrumschool.com and agree to abide by them during the time I take lessons.  I understand I may discontinue lessons at any time.
Student's Signature: (must be signed by parent if under 18) ____________________________
Print Parent's Name:_____________________