Under 18 Registration Form

EARLY YEARS/CHILDREN/TEEN REGISTRATION FORM

Check all that apply: *

Voice 30 minutes $45 Voice 60 minutes $90 Voice 30 minutes 10 lesson package $450 Voice 60 minutes 10 lesson package $900 New Clients: 4 X 60 minutes SPECIAL $180 New Clients: 4 X 30 minutes SPECIAL $90

STEP 1: Total Fees *

STEP 2: Referral Discount Total: ($10 Per Registering Family You Have Referred): *

STEP 3: Subtotal (Step 1 - Step 2): *

STEP 4: 5% GST Amount (Subtotal X .05): *

STEP 5: Subtotal + GST = GRAND TOTAL *

:: general information ::

Student Name *

First

Last

MSP Number *

Age *

Please list any allergies or medical conditions we should be aware of: *

Parent/Caregiver/Guardian Name *

First

Last

Parent/Caregiver/Guardian Email *

Home Phone Number *

Mobile Phone Number *

Work Phone Number *

Place of Employment *

:: address ::

Street Number, Street Name *

City/Town *

Province *

Postal Code *

:: parent/caregiver/guardian address (if different from student ::

Parent First Name *

Parent Last Name *

Street Number, Street Name *

City/Town *

Province: *

Postal Code *

:: emergency contact ::

First Name *

Last Name *

Street Number, Street Name *

City/Town *

Province *

Postal Code *

Emergency Contact Phone Number *

Please share a little bit about you (or your child). This may include past musical experience, a natural creative tendancy, training, how you currently support their passion, etc *

PROMO CODE IF APPLICABLE *

Submit