That Music Studio | Enrolment Form

That Music Studio | Enrolment Form

That Music Studio

ENROLMENT FORM
Student Information
Student Name*

First NameLast Name
Student Age*
At enrolment
Student DOB*
DD/MM/YYYY
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Email*

Confirmation EmailConfirm email
Student Contact Number*
Please Note

Primary Contact - Person responsible for student correspondence and scheduling.
Secondary Contact - Follow up person for student correspondence and scheduling.

Emergency Contact will be nominated later in the form.
Person responsible for fees will be nominated later in the form.
Primary Contact Name*

First NameLast Name
Relationship to student*
Primary Contact Email*

Confirmation EmailConfirm email
Primary Contact Number*
Primary Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Secondary Contact Name*

First NameLast Name
Relationship to student*
Secondary Contact Email*

Confirmation EmailConfirm email
Secondary Contact Number*
Secondary Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Medical Information
YesNo
If YES, please specify
Please include treatment/medication/severity/triggers
YesNo
If YES, please specify
Please include treatment/medication/severity/triggers
Emergency Contact Name*

First NameLast Name
Relationship to student*
Emergency Contact Number*
YesNo

Accounts Information

Details of person responsible for fees
Self (Student information)Primary Contact (for student's under 18)Secondary Contact (for student's under 18)Other
Name*

First NameLast Name
Relationship to student*
Email*

Confirmation EmailConfirm email
Contact Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Availability

When can we book you in for a lesson?
MondayTuesdayWednesdayThursdayFridaySaturday
Monday Time Availability*
9am - 9pm
Tuesday Time Availability*
9am - 9pm
Wednesday Time Availability*
9am - 9pm
Thursday Time Availability*
9am - 9pm
Friday Time Availability*
9am - 9pm
Saturday Time Availability*
9am - 12pm

Terms & Conditions
Signature or Initials*

Clear
Should be Empty: