MPS Campsie – Enrolment Form

MPS Enrolment Form
Please read the current Studio Policy before completing your enrolment. All students automatically accept the Terms & Conditions stipulated upon enrolment.
1E. Mobile number*
1F. Email*
Enter a valid email address to receive important communications from MPS.
Student Details

Yourself OR another person under 18 years
1AB. Name*

Student's first nameStudent's last name
1C. Birth Date*

DayMonthYear
Age (Office Use Only)
1D. Address*

Street Address

Street Address Line 2

Suburb/TownState

Postcode
Parent/Guardian Contact

for Child or Teenage Student
2A. Name
Main contact's name
2B. Relationship to student
This contact's relation to the student
2C. Mobile number
Contact's mobile number
Same mobile number as above (1E)?
2D. Email
Same email as above (1F)?
Add another Contact (Emergency OR Additional Parent/Guardian)?

NoYes
3A. Name
Main contact's name
3B. Relationship to student
This contact's relation to the student
3C. Mobile number
Contact's mobile number
3D. Email
4A. How did you hear about MPS?

Brochure, flyer, poster, business card or other paper adSocial media or search engineOur website - MichellesPianoStudio.com.auServices directory - ActiveActivities, Kidsbook, etc.Saw us from the street - Window posters, car decalWord of mouthOther
4B. Which course are you interested in?*

Piano (private)Guitar (private)Violin (private)Music Theory (group)Course: Intro to Guitar (group)
Private lessons are one-on-one sessions scheduled weekly with a regular teacher. Available for Piano, Violin, Guitar, Singing.
Intro to Guitar is a guitar group for beginners. Learn with a bunch of friends or meet new people. Recommended for ages 7 and up. Must bring your own 6-string acoustic guitar. Max. 4 students per course. 8 week course. Subject to availability.
Learn how to write music. Theory of Music covers the fundamentals of rhythm, music history, and composition in a friendly and engaging group environment. Knowledge of theory and/or musicianship is required for higher grade AMEB certificates and diplomas. 1 hr fortnightly.
4C. Your long-term goals as a student at MPS?
e.g. To do graded AMEB exams; learn a particular song; improve technical skills; become a confident stage performer; etc.
4D. Have you had music lessons before? Where? If not, what got you interested now?
Tell us about your experience with music education.
4E. Preferred day(s) and time(s) for weekly lessons?
Subject to availability
5A. Agreement

I understand and agree that:
- It is the responsibility of the student – myself or my child – to complete effective practise at home in order to attain progress in studies or music exams.
- In order to reschedule a lesson, I should give MPS a minimum of 24 hours notice, or notice by 9AM day of absence with a follow-up doctor’s certificate; that make-up lessons are discretionary by Management per school term; and that any unapproved missed lessons are non-refundable and non-transferable.
- If the payment of my lesson fees is not received in a timely manner, MPS reserves the right to charge a late fee of $50 on my next invoice.
- The conditions for the refund of my two-week deposit require me to give one month’s notice of termination in writing; and that, if I do not satisfy these conditions, MPS reserves the right to keep my deposit.
5B. Signature

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Parent/Guardian to sign if enrollee is under 18 years
5C. Printed name
Type your name here
5D. Today's date:

DayMonthYear
Are you human?*
ABN: 145337882 Michelle’s Piano Studio Shop 9/402 Beamish St, Campsie NSW 2194 Enquiries: 80844179. Terms & Conditions, Payment, and Notification of Absence are policies applicable when registered with the Studio.
Should be Empty:

MPS Enrolment Form

Student Details

Parent/Guardian Contact