Instrument Selection Form

Instrumental Lesson Registration Form

Fill out the form carefully for registration
Primary Caregiver Details

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Caregiver's E-mail
example@example.com
Caregiver's Mobile Number or Best Contact Number

Area CodePhone Number
Child's Full Name

First NameLast Name
Child's Current School and Class Grade ( e.g. NBPS - 3D)
TRUMPETBARITONEEUPHONIUMTUBATROMBONEFRENCH HORNFLUTEOBOECLARINETSAXOPHONEDRUMS/GLOCKENSPIELKEYBOARDELECTRIC BASS GUITAROther
GROUP LESSON ( FOR BEGINNERS)SMALL GROUP ( OPTION FOR CHILDREN IN THEIR 2ND YEARS)SHARED LESSONONE TO ONE LESSON
PAY PER TERM
Please Provide any Additional Comments

Deposit Payment for Lessons

LESSON HOLDING DEPOSIT$75.00AUD

Total $0.00AUD

Instrumental Lesson Registration Form