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Please print clearly Last Name: ______________________ First Name:_____________ Middle Initial:_____ Address: ________________________________________________________________ City: __________________ Province:_____________ Postal Code:_________________ Telephone: Home (_____)________________ Bus/Other (_____)__________________ Fax (______)______________________ E-mail: ________________________________ Gender: M F Date of Birth (MM/DD/YY): _____/_____/______ Name of your current school (If any):_________________________________________ Grade (Level): _______________ Your own instrument Grade (Level): ______________ You are a (check one): VISA Student [ ] Permanent Resident of Canada [ ] Course(s) Applying For (Check all that applies):
Private [ ] or Group [ ] How did you hear about our school? __________________________________________ * Note: All Private lessons are $25 or more per ½ hour. All Group lessons are $20 per hour. There is a registration fee of $75. IN CASE OF EMERGENCY, WE SHOULD CONTACT: Last Name: ______________________ First Name:_____________ Middle Initial:_____ Address: ________________________________________________________________ City: __________________ Province:_____________ Postal Code:_________________ Telephone: Home (_____)________________ Bus/Other (_____)__________________ _____________________________ OR ___________________________________ Applicant’s Signature Parent/Guardian’s Signature (if under 18)
Instructions on Registration:
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