www.lmjmusic.com                                                                        Lisa M. Jones B.F.A.

                                                                                                 Scarborough, ON

REGISTRATION FORM

_______________________________________________________

All fees must be paid in full prior to commencement of first lesson.

Missed lessons are the student’s responsibility and can not be refunded.

 

Parent/Guardian’s Name:____________________________________________________

 

Child’s Name: ___________________________________________________________

 

Child’s Date of Birth: ______________________________________   Age:___________

                                       (Month, Day, Year)

 

Address: _________________________________________________________________

                   Number                               Street

    

                ________________________________________________________________

                   City                                              Postal Code

 

Telephone: ______________________________________________________________

                               Home                                 Business                                 Cell

 

Lesson Day and Time: ___________________________________________________

 

Medical Information: ______________________________________________________

                                     (please list any allergies, medical conditions or special needs)

 

____yes ____no   L.M.J. Music and Lisa M. Jones has my permission to publish my child’s photo in

L.M.J. Music promotional materials/and or the L.M.J. Music website.

 

Method of Payment:    Cash___________     Cheque______________

                                                      (Please make cheque payable to L. M. Jones)

 

Total Fee:     $ _______________

 

Waiver: In case of emergency, I authorize Lisa M. Jones to obtain medical attention. 

I release Lisa M. Jones, teachers and staff of all liabilities in case of accident or injury. 

I certify that all of the information listed on this registration form is complete and accurate. 

I have been provided with a copy of all L.M.J. Music policies, and accept and agree to these policies.

 

 

Date: _______________ Signature: _________________________________