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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 _____________ _________________________ _____________________ _____________ _________________________ _____________________ _____________ _________________________ _____________________ _____________ _________________________ _____________________ _____________ _________________________ _____________________

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