KMA 2024 Enrolment Form
STUDENT INFORMATION
Full Name
Preferred Name:
DOB
Gender:
Male
Female
N/A
Pronouns
He/Him
She/Her
They/Them
Other
Instrument of choice
Allergies/Medical conditions/Learning needs
If so, list medications/care procedure (or attach Action plan)
Creative Kids Voucher Number:
PARENT INFORMATION
Name
Email
*
example@example.com
Contact no.
*
How did you hear about us?
Please Select
Facebook
Instagram
Website
A Friend
Westfield Performance
Other
Options for payment of fees:
Full term payment via direct transfer (no fees)
Full term payment via credit card (once off 1.75% fee)
Fortnightly direct debit 5x smaller payments per term (1% + 0.40 cents per transaction)
Disclaimer:
I have read and agree to the KMA Student Policy.
I
understand that I am to collect my child from the studio immediately after their lesson (For primary aged students: if you wish for your child to leave the studio and meet you on the street please email us with a written permission).
Signed & Date
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