Onsite Enrollment Form

Enrollment Form

Fill out the form carefully for registration.
Student Name:*

First NameMiddle NameLast Name
Birth date:*

MonthDayYear
Date
Age:*
Gender:*

MaleFemale
Does the student have any special conditions or needs we should know of? (e.g., medical conditions, learning preferences, or special needs):*

YesNo
Please specifiy:*
Guardian's Name:*

PrefixFirst NameLast Name
Relationship:*
Phone Number*
Please enter a valid phone number.
E-mail Student/Guardian:*
example@example.com
Address:*

Please input your complete address.

Street Address Line 2

CityState / Province

Postal / Zip Code
Landmark:
Instruments: (one package per instrument)

VoicePianoGuitarViolinUkuleleDrumsClarinetSaxophoneFluteCello
Arts: (one package per art lesson)

Creative DrawingSketchingAcrylic PaintingWatercolor PaintingManga DrawingSculpture
Extension Program: (one package per lesson)

Swimming
Student Level:

StarterBeginnerIntermediateAdvance
Schedule: (List all availability)*

Lesson Packages:*

Home Service Lessons

12 LessonsHome Service: 1-hour/lesson

20,000.00PHP Quantity

6 LessonsHome Service: 1-hour/lesson

11,800.00PHP Quantity

3 LessonsHome Service: 1-hour/lesson

6,500.00PHP Quantity

Online Lessons

12 Lessons Online: 1-hour/lesson

10,600.00PHP Quantity

6 LessonsOnline: 1-hour/lesson

6,200.00PHP Quantity

3 LessonsOnline: 1-hour/lesson

3,600.00PHP Quantity

Studio Lessons

12 LessonsStudio: 1-hour/lesson

18,300.00PHP Quantity

6 LessonsStudio: 1-hour/lesson

10,700.00PHP Quantity

3 LessonsStudio: 1-hour/lesson

5,900.00PHP Quantity

Swimming Lessons

6 LessonsHome Service: 1.5-hour/lesson

12,600.00PHP Quantity

12 LessonsHome Service: 1.5-hour/lesson

21,800.00PHP Quantity

24 LessonsHome Service: 1.5-hour/lesson

36,800.00PHP Quantity

Enter coupon

Total

0.00PHP

Payment Method:*

BDO: 008458013567 (Pontem Ventures Inc.)GCash: 09109639182 (Ma. Teresa Sevilla)Cash / Credit Card: Pay at the Office: Mezzanine Unit M03, Lanzilia Bldg. #4-A J. P. Rizal Extension, National Rd., Brgy. West Rembo, Taguig City.
Payment Method:*

BDO: 008458013567 (Pontem Ventures Inc.)GCash: 09173090155 (Mary Joy Sevilla)Cash / Credit Card: Pay at the Office: Mezzanine Unit M03, Lanzilia Bldg. #4-A J. P. Rizal Extension, National Rd., Brgy. West Rembo, Taguig City.
Image Upload: Receipt of Enrollment Fee *

Cancelof
How did you know about us?*

Online Search (Google, Bing, etc.)Social Media (Facebook, Instagram, etc.)Referral
Referred by:*
TERMS & CONDITIONS:

1. Client agrees that cancelled classes must have a make-up which may be scheduled on a different day and time from the regular schedule.

2. Preferred schedule is subject for confirmation with the Coach. We don't guarantee your preferred schedule is open. First come, first serve policy.

3. Non-appearance in class without notice atleast a day before the schedule will be forfeited.
NO REFUNDS:

Please be advised that refunds are not allowed after the enrollment process has been completed.

Flexible Options:

1. Transfer to Immediate Family Members (at least once)

2. Program Transfer (at least once)

3. Coach Re-assignment (at least twice)
I authorize Pontem Music and Arts PH to collect, use, and process my personal data for enrollment, communication, and administrative purposes.
I have read and fully understand that refunds are not allowed.
Signature*

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