Summer Lesson Registration Form

Please check which instrument(s) you would like to register for: *

Please check which platform(s) you would like to register for: *

Lesson Length *

Preferred Lesson Date(s) & Time(s) Between July 5 & 31 ( (lessons unavailable during stat holidays)

Preferred Lesson Date(s) & Time(s) Between August 1 & 31 (lessons unavailable during stat holidays) *

Name *

First

Last *

Last

Phone Number *

Email *

Name and Age of Student *

Name(s) of adult(s) who will be home during the lesson(s) *

Amount and types of pets on premises *

Address (complete with Postal Code and any necessary Parking Instructions) *

Relevant Medical Information (eg. allergies, medication, learning challenges, etc.)

Emergency contact information. Name, Cell Phone, Relationship to student. *

I would like to use the following method of payment to secure my summer lessons *

Musical Goals for the Summer

Promo Code

I understand that, once confirmed by email/text, there is no refund available and that I will need to purchase another lesson if I need to reschedule. *

Agree

Additional information or message:

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