PART-TIME Enrolment Form

Lesson Selection
Guitar / BassKeys / PianoDrums / PercussionVocalsViolinMusic ProductionMusical TheatreJACOB SWANN Song WritingEnsemble Singing
Student Details
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Gender*

MaleFemalePrefer not to sayOther
Language(s) spoken at home*
Email*
example@example.com
Cell Number*
Please enter a valid phone number.
Permanent Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any medical, learning, or mental health conditions that we should be aware of to better support you during lessons? (For example: ADHD, ADD, or any specific learning needs.)
In the event of Emergencies

Please provide details who we can call
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
How did you hear about us?*

Education AgentCareer & Education ExpoCareers AdviserBillboardPrint / NewspaperWord of MouthGoogle or other search engineOther
If chosen other, please specify*
Person Responsible for Payment

Learners pay the Rate, as well as the once off registration fee of R390 in advance before first lesson commences
Association*

Adult LearnerMotherFatherOther
Please select your payment preference*

Per Term PaymentPer Month PaymentVoucher Sytem
Name*

First NameLast Name
ID Number
Passport Number
Mobile*
Person responsible for Payment Email*
example@example.com
Payment Terms

Please Note: Even if you choose to pay via EFT, a signed debit order form is still required. This serves as a precautionary measure—should any payments be missed, we reserve the right to process the debit order.
Payment Option*

EFTDebit Order
1.Banking Details

M&M Music Academy (Pty) Ltd

Standard Bank

Branch Code: 022209

Account No: 27 111 748 6

SWIFT Code: SBZAZAJJ

Reference: NAME & SURNAME
Declaration

Kindly ensure you read the terms and conditions.
Applicant Type*
Signature*

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Date

DayMonthYear
Debit Order Consent Form

Authority and Mandate for payment instruction: Electronic and Written Mandates
Personal Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Details
Bank Name*
Branch Name*
Account Number*
Branch Code*
Amount*
Account Type*

Cheque AccountSavings AccountCredit AccountOther
Debit Order Date*

DayMonthYear
Date
Date of Enrolment*

DayMonthYear
Date
The individual payment instructions so authorized to be issued as followed: monthly.

In the event that the payment day falls on a Sunday or a recognized South African public holiday, the payment day will automatically be the preceding ordinary business day.

I / We understand that the withdrawals hereby authorized will be processed through a computerized system provided by the South African Banks and I also understand that the details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction.

Mandate I / We acknowledge that all payment instructions issued by you shall be treated by my / our abovementioned Bank as if the instructions have been issued by me / us personally.

Cancellation I / We agree that although this Authority and Mandate may be cancelled by me / us, such cancellation will not cancel the Agreement. I / We shall not be entitled to any refund or amounts which you have withdrawn while the Authority was in force, if such amounts were legally owing to you.

Assignment I / We acknowledge that this Authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.
I allow this form to collect sensitive information like my bank details. I also confirm that all information on this form is true and complete
Authorisation
The signed Authority and Mandate refers to our contract as dated on the Enrolment Form (“The Agreement”). I/We hereby authorize you to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my / our abovementioned Bank (or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations, as agreed, to in the Agreement and commencing as per agreed Date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of not less than 20 ordinary working days.
Signature*

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Date*

DayMonthYear
Date
Should be Empty:

Lesson Selection

Student Details

In the event of Emergencies

Person Responsible for Payment

Payment Terms

Declaration

Debit Order Consent Form

Personal Information

Bank Details