Music Registration
Piano, Guitar, Bass, Drums, Beginner Ukulele, Vocal - lessons are 1/2 hr individual sessions.
Student Name
Age
Instrument
*
Guitar
Bass
Drums
Beginner Ukulele
Vocal Lessons (Thursday Evenings)
Preferred Day of the week - Day of the week will depend on availability. Once registration is received KPAC staff will contact you to confirm day and time
*
Monday
Tuesday
Wednesday
Thursday
Friday
Please select your instructor
Breydon Janzen (Guitar, Bass, Drums, Beginner Ukulele - Mon-Fri)
Troy Rushton (Guitar, Bass - Wed/Thurs)
Sanya Suri (Vocal - Thursday Evenings)
Preferred Time between 2:30 pm-8:30 pm-Lesson time will depend on availability. Once registration is received KPAC staff will contact you to confirm day and time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Birthday
*
-
Month
-
Day
Year
Date
Parent/Guardian #1 Name and Phone Number
Parent/Guardian #2 Name and Phone Number
Custody Arrangement
Address - Please include your postal code
*
Phone
Email
Emergency Contact : Name & Phone
Relationship to Student
Allergies or Medical Conditions
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Music Registration - Payment
Payments for lessons are due at the BEGINNING of each term. There a total of 5 terms per year. Term 1 Sept-Aug, Term 2 Nov-Dec, Term 3 Jan-Feb, Term 4 Mar-Apr, Term 5 May-Jun
Payment Options
*
Pre Authorized Visa or MC
Homeschooling Funding or Jumpstart
E-Transfer (Generic password will be given)
Person Responsible for payment
Membership- Must be renewed annually
*
Sept 1- Feb 28 $20
Mar 1- Aug 21 (Prorated) $10
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Waivers
Please Read and Acknowledge
$50 registration fee that is NON refundable - DUE 24hrs after invoice is sent
*
Yes
I understand that lessons must be paid in FULL by cash, debit, EMT, or credit card at the beginning of each term. (September, November, January, March,May)
*
Yes
If payment arrangements are not made prior to the beginning of each term, 7% late fee will applied on the 15th of the month, compounding monthly.
*
Yes
I understand that Myself or my Child are enrolled in the KPAC Music Program from September to June unless written notice has been given.
*
Yes
I understand that written notice (email or paper) must be given at least two weeks in advance to withdraw from the Music program.
*
Yes
I understand that I will be required to pay for two weeks worth of lessons if adequate notice is not given.
*
Yes
I understand that I am responsible for payment of lessons that I or my Child miss. (ex: illness or vacation)
*
Yes
I understand that by signing this form I am solely responsible for payments of all fees when due. If applying for 3rd party funding, fees must be paid to KPAC before the beginning of each term. Otherwise the student may not be permitted to take lessons. KPAC will reimburse families once payment from the 3rd party has been received.
*
Yes
I understand that Term fees MUST be paid in full prior to the start of the next term.
*
Yes
PHOTO/VIDEO WAIVER- YES/NO I, the undersigned, authorize KPAC and its staff to use any photo/video of me/my child taken during class time, rehearsals, and performances to be used to market and promote the Kiwanis Performing Arts Centre in printed and other media publications, including but not limited to Facebook, City of Dawson Creek Leisure Guide, KPAC Brochures, and the KPAC website.
*
Yes
No
I understand that I will have to pay $$ upon arrival
*
Yes
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