Children's Class Enrolment Form
Name of Student
First Name
Last Name
Date of Birth
*
Pronouns
Please Select
He / Him
She / Her
They / Them
Other
Choice of Class
Please Select
Musical Tots (0-3 Years)
Piano Tots (3-5 Yrs)
Piano Kids (5-9 Yrs)
Junior Musicianship (Primary 1-3)
Early Years Music (3-5 Years)
Guitar Kids (7+ Yrs)
Grade 3 Theory (7+ Yrs)
Grade 1 Theory (7+ Year)
Grade 4 Theory (7+ Years)
Theatre Kids (7+ Years)
Permission
*
Yes - I give permission for the student to be included in photos taken by the music academy during the class that may be used on social media and other publicity materials.
No - I do not give permission for the student to be included in photos taken by the music academy during the class that may be used on social media and other publicity materials.
Emergency Contact & Parent / Guardian Name
First Name
Last Name
Parent / Guardian Pronouns
Please Select
He / Him
She / Her
They / Them
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Terms & Condtions
I agree
*
I have read the terms & conditions and agree
I understand that upon signing up for any class after the trial period, it is an annual subscription with no cancellations mid-year (August - June)
I wish to receive emails from Brick Lane Paisley
Submit
Should be Empty: