November 5, 2017

Application Form – Children’s 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 ~

 

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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