Registration FormsPlease read our Policies and Procedures before completing forms Weekly Lessons Trial Lessons Weekly Lessons Registration Form Registration Form Student's Name * Parent(s)/Guardian(s)/or state Adult Student if over 18 * Student's Birth Date * Email * Full Address(es) & Parking Instructions If Applicable * Phone Number * Preferred Method of Communication Email Phone Text Does not matter Other Preferred Method of Communication Name of (and relationship to) the Adult most likely to be home during the lesson (if the student is a minor) * Emergency Contact Name, Number, and Relationship to student * This will be someone OTHER than the person regularly at the home during the lesson Types of pets in the house (if applicable): Medical Information (if applicable ie. Allergies, instructions, etc.): Instrument(s) * Piano Violin Guitar Voice Viola Ukulele Theory Drums Bass Guitar Stand Up Bass Rock Band Summer Camp Violin Intensive Summer Camp Violin & Piano Violin & Guitar Voice & Piano Voice & Guitar Violin, Piano, Guitar Guitar & Bass Drums & Guitar Guitar & Piano Voice, Guitar & Piano Other Instrument(s) Level (New Students Only) Complete Beginner Beginner with prior musical education Adult Beginner Beginner to Intermediate (1-5 years of instruction) Intermediate Advanced Other Facebook Trial Lesson Offer Level (New Students Only) Lesson time options (returning students only) If it is still available, I would like to keep my lesson time and day the same I am not sure yet what time will work for me in the Fall but would still like to register during this time I would rather not keep my current lesson time in the Fall but if there isn’t a better alternative I can keep it I would like to change my lesson time and/or day. Please see below for my top 3 choices Lesson time increase (returning students only) 15 Minutes 30 Minutes 45 Minutes Other Lesson time increase (returning students only) Additional Comments: Top 3 choices for a weekly lesson day & time. ie. Mondays @ 5pm 1st Choice * 2nd Choice 3rd Choice Payment Options Please select your payment Option * Credit Card on File: Please use credit card you have on file for me (Returning Students Only) Credit Card: After submitting this form, someone will contact you by phone to gather your Credit Card Details. You may also call our secure line 604-338-2742 to speak with someone or leave a message. E-transfer: Please send an initial e-transfer to firstname.lastname@example.org for the annual registration fee (30.00) and for the first month of lessons. E- transfers can then be scheduled with your bank for the first of every month thereafter until June of the current school year (or after 30 day notice is given in the case of termination). Note: A Backup Credit Card is required on file to qualify for this option. Please call 604-338-2742 to provide details. In the event that the payment is not received by the first of each month, your credit card will be charged for the lesson amount and a non-process fee (NPF) of $25. Post-Dated Cheques: Please mail [102-1424 Martin St. White Rock, BC V4B3W7] the annual registration fee (30.00) + 10 post-dated cheques for the first of each month Sept-June. See chart in Policies and Procedures for specific monthly amount. Cheques can be made payable to "Music for Life/Tina Tate." Note: A Backup Credit Card is required on file to qualify for this option. Please call 604-338-2742 to provide details. There is a $25 NSF fee and lessons can be withheld until the matter is resolved. Confirmation I have read, understand, and will adhere to the Policies and Procedures. I am aware that policies may change and that I will be notified by email * Yes read, understand, and will adhere to the Policies and Procedures. I am aware that policies may change and that I will be notified by email By Checking the Box Below You certify that the information provided on this application is accurate. I understand that withholding of information or giving false information may result in discontinuation of services * Yes the information provided is accurate and correct Enter Full Name * Today's Date * If you are human, leave this field blank. Download printable version here Trial Lesson Registration Trial Lesson Registration Please check which instrument(s) you would like to register for: Piano Guitar Voice Violin Electric Bass Drums Theory OtherOther Please check which format(s) you would like to register for: In-person Zoom Skype WhatsApp Facetime Google Duo Facebook Messenger OtherOther Does not matter Lesson Length 30 minutes 32.99 45 minutes 45.00 60 minutes 59.00 15 minutes 20.00 (pre-school sibling intro to music session) Preferred Lesson Date & Time * Alternate Lesson Date & Time * Name * First Last * Last Phone Number * Email * Name and Age of Student * Address (complete with Postal Code and any necessary Parking Instructions) * In-home lesson format: are there any pets on the premises? If so, please indicate type. If not, please indicate N/A. Relevant Medical and/or Learning Information (eg. allergies, medication, ADHD, ASD, etc. - anything that might be useful for the teacher to prepare for an optimal lesson). All information is kept confidential between admin and your teacher only. Emergency contact information aside from adult who will be home during the lesson. Name, Cell Phone, Relationship to student. * Musical background (if any), musical goals/requests I would like to use the following method of payment to secure my trial lesson * Visa MasterCard E-transfer Promo Code I understand that, once confirmed by email/text, there is no refund available and that I will need to purchase another trial lesson if I need to reschedule. * Agree I understand that in the case of an illness with either the teacher, the student, or their households, (or if BC government regulations change to not allowing in-home services) then the lesson will automatically be switched to a virtual lesson. * Agree I understand that for an in-person lesson, an adult needs to be on the premises for the duration of the lesson; for a virtual lesson, an adult needs to be present in the same room as the student in order to help with instructions for the duration of the lesson. * Agree Mailing List Please email me more information about other services/promotions the Music for Life School of Music has to offer Captcha Additional information or message: Tell us how you heard about us! Google Search Yahoo Search Facebook Ad on car Poster From a friend From one of our teachers OtherOther If you are human, leave this field blank.