Application Form – Children’s Lessons

Stella’s Notes

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

 

PUPIL INFORMATION

NAME:	_____________________________
SURNAME:	_____________________________
AGE:	_____________________________
GENDER:	_____________________________
BIRTHDAY:	_____________________________
FAVOURITE COLOUR:	_____________________________
FAVOURITE TREAT:	_____________________________
DOES THE PUPIL AND HIS/HER FAMILY CELEBRATE BIRTHDAYS?	YES  /  NO
DOES THE PUPIL AND HIS/HER FAMILY CELEBRATE CHRISTMAS?	YES  /  NO
IS IT ACCEPTABLE TO REWARD THE PUPIL ON CERTAIN OCCASIONS?	YES  /  NO

 

 

 

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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