Application Form – Adult Lessons

Stella’s Notes

Cell: 074 407 6090
E-mail:
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APPLICATION FORM – MUSIC LESSONS 2018
~ PLEASE COMPLETE ONE PER STUDENT ~

 

STUDENT INFORMATION

NAME:	_____________________________
SURNAME:	_____________________________
AGE:	_____________________________
GENDER:	_____________________________

 

PARENT/GUARDIAN INFORMATION

MOTHER/GUARDIAN

NAME:	_____________________________
SURNAME:	_____________________________
CONTACT NUMBER:	_____________________________
E-MAIL ADDRESS:	_____________________________

FATHER/GUARDIAN

 

NAME:	_____________________________
SURNAME:	_____________________________
CONTACT NUMBER:	_____________________________
E-MAIL ADDRESS:	_____________________________

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I, ________________________________________________, have read the “Stella’s Notes” policy and hereby agree to the terms.

SIGNED:	_____________________________
DATE	_____________________________

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