Online Registration Form

Course Registration

Please note, all fields indicated with a red asterisk (*) must be filled in before submitting the Registration Form.

STUDENT INFORMATION

* Indicates required field

Name of Student *

First

Last

Student's Email Address *

Home Phone Number *

Street Address (Optional) *

City/Town *

Province *

Postal Code *

Grade in School *

Age *

STUDENT'S MUSICAL BACKGROUND

Level in Music (e.g. Grade 8 RCM) *

Level of Theory (e.g. Basic Harmony, or Advanced Rudiments etc) *

Primary Instrument *

Other Instruments and Level *

Teachers I'm currently studying with: (List private music instructors) *

Additional Comments (Is there anything I should know about your child) *

PARENTAL/GUARDIAN INFORMATION (If you are a mature student, fill this section in with your own information)

Parent/Guardian 1 *

First

Last

Email Address *

Primary Phone Number *

Cell Phone Number *

Work Phone Number *

Parent/Guardian 2 *

First

Last

Email Address *

Primary Phone Number *

Cell Phone Number *

Work Phone Number *

Address if different than above *

COURSE REGISTRATION

I am registering for: *

Other, if selected above. *

I am planning on writing the exam in the following exam session: (State month and year of exam session). *

I have read the Course Outline and understand that there is no refund from early withdrawal from a course. *

Yes No

PAYMENT OF TUITION *

Additional Comments *

Thank you for your registration.

The Registration Form will be sent when you click on the SUBMT button below. You will receive confirmation (on the next screen) that your registration form has been submitted. I'll be in contact with you shortly to confirm your registration and to give you further details. If you do not receive confirmation of your registration, or hear back from me within 24 hours, please email me directly.

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