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PJ Music Studios New Student Registration Form
We are so excited to have you join our musical community! Please fill in the fields below. If you have any questions please contact us. We understand that your privacy is important and your privacy policy can be found on our web site:
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* Indicates required question
Student Information
Student First Name
*
Your answer
Student Last Name
*
Your answer
Year of Birth
*
Your answer
Date of Birth (optional)
MM
/
DD
/
YYYY
Phone Number
*
Your answer
Email
*
Your answer
Address
Your answer
Parent (or Guardian) #1 - Name
Your answer
Parent (or Guardian) #1 - Phone or Email
Your answer
Parent (or Guardian) #2 - Name
Your answer
Parent (or Guardian) #2 - Phone or Email
Your answer
Payment Information
Method of Payment
*
Cheque
Direct Deposit
Other:
Required
Person(s) Responsible for Payment
*
Your answer
Music Lesson Information
Categories
*
Piano
Guitar
Vocal
Strings
Brass
Woodwind
Precussion
Theory
Composition
Other:
If you select Strings, brass, or woodwind, please enter specific instrument:
Your answer
If you select Guitar, please choose one of the following genres:
Choose
Classical
Flamenco
Jazz
Electric
Bass
Name of Preferred Teacher
Your answer
Level of Study (for example, RCM grade)
Beginner
Prep A
Prep B
1
2
3
4
5
6
7
8
9
10
ARCT
Popular
Other:
Clear selection
* If you chose "Other", please enter details (for example, theory, Composition, ...):
Day of Your Classes
*
Choose
Monday
Tuesday
Wednesday
Thurday
Friday
Saturday
Sunday
Time of Your Classes
*
Time
:
AM
PM
Referred by
Your answer
Are you taking more than one subject (piano, guitar, violin, theory, etc...)
*
Yes
No
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