One to One Tuition Enrolment

Student First Name

Student Last Name

Student Pronouns Student PronounsHe/HimShe/HerThey/ThemOther

Student Date of Birth

Instrument of Choice Instrument of ChoiceAcoustic GuitarBass GuitarCelloClarinetDrumsElectric GuitarFlutePianoSaxophoneSingingTheoryTrumpetUkuleleViolin

Preferred Lesson Day & Time

Permission Permission I give permission for the student to be included in photos taken by the music school during the class that maybe used on social media and other publicity materials.

Emergency Contact First Name

Emergency Contact Last Name

Pronouns PronounsHe/HimShe/HerThey/ThemOther

Relationship to Student

Address

Telephone

Email

Terms & Conditions Terms & Conditions I have read the terms & conditions and agree

Mailing List Mailing List I wish to receive emails from Brick Lane Paisley