PJ MUSIC STUDENT REGISTRATION
PJ MUSIC STUDIOS 2022-2023
REGISTRATION FORM DATE RECEIVED _______________________
I have read the PJMUSIC STUDIOS POLICIES and wish to enroll the following student(s)for piano lessons for the term of 2022/2023. I understand that I am reserving a time slot for the entire year, and that post-dated cheques for tuition for the year are due with the registration form and registration fee on or before Sept 30, 2022 for returning students to qualify for the reduced registration fee. If I own an acoustic piano, I agree to have it tuned at least once a year.
Signature _______________________________________ Date ________________________
NAME OF STUDENT ______________________________________________
ADDRESS Street: ____________________________________________
Town ______________________
Mailing address: ______________________________________________________________
Code: ________________
Email Address: ___________________________________ Telephone Numbers:
HOME __________________
WORK ___________________________ CELL______________________________
CELL __________________________________
PARENT(S) NAME(S) _________________________________________________________
BIRTH DATE _____________________ GRADE IN SCHOOL _______________________
WHAT INSTRUMENT OWNED - KEYBOARD _____ DIGITAL _____ACOUSTIC ______
(List Make, Model # (Digital) & Serial # (Acoustic)
MAKE_____________________ MODEL #______________ SERIAL # _________________
DATE ACOUSTIC PIANO LAST TUNED_______________________________________
LESSON TIME PREFERRED: Morning ____ Afternoon ______ Evening ______
LENGTH OF LESSON: 15 min. 30 min. _____ (only available for young beginners) 45 min. _____1 hour _____
DAYS & TIMES AVAILABLE - Please list ALL days available, as well as the range of ALL times available for each day, in order of preference.
1. Day _____________ Times ________________________________________________
2. Day _____________ Times ________________________________________________
3. Day _____________ Times ________________________________________________
4. Day _____________ Times ________________________________________________
5. Day _____________ Times ________________________________________________
FOR TEACHER’S USE ONLY No. of Lessons Monthly Payment Rec’d 1 st Lesson Registration Fee Rec’d Day and Time of Lesson Booked Books to order RECORD OF LESSONS MISSED DATE REASON MAKE UP DATE _____________ _________________________ _____________________ _____________ _________________________ _____________________ _____________ _________________________ _____________________ _____________ _________________________ _____________________ _____________ _________________________ _____________________