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
Is the student under the age of 18 years?
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
Would you like at add another contact?
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
Allergies
If YES, please specify
Please include treatment/medication/severity/triggers
Medical Conditions
If YES, please specify
Please include treatment/medication/severity/triggers
Emergency Contact Name

First NameLast Name
Relationship to student
Emergency Contact Number
In case of an emergency, do you give That Music Studio permission to call an ambulance?

Accounts Information

Details of person responsible for fees
Who will be responsible for fees?
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?
Please select the days of the week that you are available for lessons
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
Should be Empty: