Accordion Groups
Accordion Kids / Accordion & Coffee
Who are you enrolling?
Please Select
Yourself as an adult learner
A child you are the parent / guardian for
Name of Student
First Name
Last Name
Date of Birth
*
Learners Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Learners Email
example@example.com
Learners Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Pronouns
Please Select
He / Him
She / Her
They / Them
Other
Choice of Class
Please Select
Accordion Kids 6.30pm - 7.30pm (4 week block 17th, 24th September 1st, 8th October)
Accordions & Coffee - 7.30pm - 8.30pm
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
Emergency Contact Name:
First Name
Last Name
Parent / Guardian Pronouns
Please Select
He / Him
She / Her
They / Them
Other
Emergency Contact 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 understand that by signing up, I am committing to the full five-week period, and that classes are non-refundable if I am unable to attend.
I wish to recieve promotional emails from Brick Lane Paisley
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