Enrolment Form
Once you've submitted your info, I'll get back to you asap to confirm your day & time.
Student's Details:
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First Name
Last Name
Age (if under 18)
Parent/Guardian's Name (if student is under 18yrs):
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First Name
Last Name
Email: (for billing & news)
*
Please check your junkmail folder for our response!
Phone Number:
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eg 0400-123-456
Billing Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I'd like to learn...
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Guitar
Drums
Bass
Double Bass
Ukulele
I'd like to have...
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Ongoing Private Lessons
Ongoing Group Lessons
Casual Lessons
A Trial lesson
I'd like to learn on either of these days...(choose two)
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Monday
Tuesday
Wednesday
Thursday
My first time preference would be...
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Please Select
2.15pm
2.45pm
4pm
4.30pm
5pm
5.30pm
6pm
6.30pm
My second time preference would be...
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Please Select
2.15pm
2.45pm
4pm
4.30pm
5pm
5.30pm
6pm
6.30pm
What best describes your experience level...
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Please Select
Completely new to playing an instrument.
Been dabbling a bit at home.
Been learning for around a year.
Been playing for a few years.
Intermediate player.
I'm awesome.
I should be teaching you, pal!
Do you have an instrument?
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Please Select
No.
No, but would like to chat about what to buy.
Yes, but it may need a bit of a service / fix up.
Yep, I have an instrument in perfect working order.
Any notes or questions for me? Allergies, special needs, billing queries etc
*
I have read, understand and agree with Horsham Music Tuition's Terms & Conditions.
Submit
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