New Student Enrolment 2021/2022
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STUDENT INFORMATION
Student First Name *
Student Surname *
Date Of Birth *
MM
/
DD
/
YYYY
Address *
Parent / Guardian Name (if applicable)
Phone Number *
Email Address *
How did you hear about Mezzo Music Academy? *
Do you wish to rent an instrument from Mezzo for the term? *
Does the student have a medical condition, or any additional learning or behavioural needs? *
If yes, please give details. This information will be treated with the strictest confidence. It is important that the teacher is made aware of any circumstances which might affect the student's wellbeing, behaviour, or ability to learn.
Please describe the student's previous musical experience, if any.
What styles of music would the student like to focus on?
CLASS SCHEDULING
Term Type *
Select Instrument(s) (Private & Group)
Select Course(s) (Group Classes)
Lesson Type
Clear selection
Private Lesson Duration
Clear selection
Teacher preference
Day & Time Preference (please choose at least 3 options)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
9am - 11am
11am - 1pm
1pm - 3pm
3pm - 5pm
5pm - 7pm
7pm - 9pm
Any additional information regarding day & time slots:
PAYMENT
How will payment be made? *
Submit
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