Summer of Fun - 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
Magical Musicians 20th july - 23rd July
Starstruck Summer 13th July - 16th July
Starstruck Summer 27th July - 30th July
Rock Pop & Rap Summer Camp 20th July - 23rd July
Piano Kids - 10th July
Piano Kids - 17th July
Piano Kids 24th July
Piano Kids 31st July
Piano Kids - Multi Week Option
Permission
*
I give permission for the student to be included in photos taken by the music school during the class that maybe used on social media and other publicity materials.
I do not permission for the student to be included in photos taken by the music school during the class that maybe 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
Instalment Payments
I agree
*
I understand that my space is not secured until my deposit has been paid
I understand that my deposit is non-refundable
I wish to receive emails from Brick Lane Paisley
Submit
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