Academy Of Music Registration

Academy of Music Brampton

Registration Form
Student Name*

First NameLast Name
Birthday

MonthDayYear
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Instrument*
Please choose the days and times you are available below. Lessons are 1/2 hour private once per week. If you have already been in contact with us and confirmed a time please choose time accordingly.

AFTER SUBMITTING WE WILL CONTACT YOU WITH ALL AVAILABLE TIMES BASED ON YOUR REQUESTS.
Click Which Day(s) Available*

MondayTuesdayWednesdayThursdaySaturday
Weekday Time 3:30-9pm (Only)*

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
Saturday Time 10am to 5pm (Only)*

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
Home Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Other Phone

Area CodePhone Number
Primary Email*
example@example.com
Secondary Email
example@example.com
Please Inform Us Of Any Requests Or Concerns
I have read the Studio Policy Below*

Yes
Current Lesson Prices

$33 Per 1/2 Hour
Should be Empty:

Academy of Music Brampton