Enrolment form

EMS-ACG PARNELL MUSIC ACADEMY
2 Titoki Place, Parnell, Auckland 1010

emschool@xtra.co.nz

www.epsommusicshcool.co.nz

021 170 9704
Chambermusic Spring Holiday Program

Please fill in where applicable. Please note that this form is NOT an application form. We are using this to determine the number of applicants. A separate enrolment form will be sent directly to you via email given here.
- Student Name*
  
  First NameLast NamePreferred Name
- Current School/University/Workplace*
- Birth Date*
  
  MonthDayYear
- Gender*
- School Year Level in 2025*
- Instrument *
- Student's approx. level*
- Parent / Guardian name*
  
  First NameLast Name
- Relationship to Student*
  i.e. Mother, Father, N/A
- Contact number*
  
  Area CodePhone Number
- Email*
  example@example.com
- Should be Empty:

Chambermusic Spring Holiday Program