November 5, 2017

Application Form – Adult Lessons

Stella’s Notes

Cell: 074 407 6090
E-mail: stellzt@gmail.com
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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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