Rachel Loerts Music Registration Form
Please fill out this form to enroll yourself/your child in weekly music lessons.
Student's Name (First and Last) *
Your answer
Age *
Your answer
Birthday *
Allergies/Dietary Restrictions
(if applicable) Please note that there is at cat in the house, but it does not go into the music room where lessons are taught.
Your answer
Additional Relevant Information
(Interests, hobbies, learning disabilities, chronic illnesses, etc.)
Your answer
Instrument *
Lesson Length *
Musical Interests *
Check all that apply.
Level *
Preferred Lesson Date and Time
Sundays (all instruments) 9 am until 5 pm,
Wednesdays (voice & piano only) 3:30 pm until 9 pm

View a calendar of taken lesson times here: http://www.rachelloertsmusic.com/lesson-information.html
Top three preferred lessons dates and times
First Choice *
(eg. Wednesdays 4-4:30)
Your answer
Second Choice
Your answer
Third Choice
Your answer
Fees and Refund Policy
- Weekly half-hour lessons: $22 per half hour
- Weekly one hour (or more) lessons: $20 per half hour.
- Fees are due at the first lesson of the month and cover the entire month.
- Fees can be paid via cash, cheque made out to Rachel Loerts or e-Transfer to loertsra@gmail.com.
- If one wishes to withdraw from lessons before the end of the month, they will not be refunded barring special circumstances dealt with on a case by case basis. Please refer any fee and refund issues to Rachel.
- Returned or NSF cheques will incur a $5 fee or any other amount charged to cover expenses levied against Rachel Loerts’ account.
Attendance, Cancellations, and Make-up Policy
- Students are expected to arrive on time for their lessons with their books and other lesson materials.
- Time will not be made-up or added on to the end of the lesson if a student is late.
- ​Please advise us of absences before the month’s invoice is due, or a minimum of one week in advance.
- In the case of illness and emergency, please advise us of the absence as soon as possible.
- Missed lessons will generate a make-up lesson credit for the student which must be used by the end of the month, or can be applied to the next month’s bill.
- If we are not notified about the absence, no make-up lesson credits will be applied.
- Lessons cancelled by the instructor will be made up based on your availability or refunded on the next month’s bill.
Holiday Information
There are no lessons or make-ups on:

Good Friday (Friday, April 19, 2019)
Victoria Day (Monday, May 20, 2019
Canada Day (Monday, July 1, 2019)
Labour Day (Monday, September 2, 2019)
Thanksgiving (Monday, October 14, 2019)
A two-week holiday break from Sunday, December 22, 2019, to Saturday, January 4, 2019

The following dates are optional lessons:

March Break (Monday, March 11, 2019, to Friday, March 15, 2019)
Easter Sunday (Sunday, April 21, 2019)

​If there are any other holidays that your family observes and would not like to have lessons on, please advise us. ​ ​
Books and Lesson Materials
- No books are required for trial lessons. The best book for a student can be recommended in the trial lesson and general recommendations can be found at rachelloertsmusic.com.
- Each student is required to buy a lesson and theory book, and a 3-ring binder for their lessons. These can be purchased through Rachel Loerts Music.
- Other additional materials can be found on the specific instrument lesson page.
- Additional sheet music photocopies and original Rachel Loerts and Rob Haynes arrangements will be provided to the student by the teacher at no extra charge.
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Phone Number(s) *
And/or student's number.
Your answer
Parent/Guardian Email Addresse(s) *
And/or student's email address.
Your answer
Address *
Your answer
Consent *
I have read, and agree to the conditions listed above.
Media Consent *
I give Rachel Loerts Music permission to use any pictures or videos that may be taken of me/my child at music lessons and performances.
How did you hear about Rachel Loerts Music? *
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