ENROLLMENT FORM

Please print out, complete and sign this form, and return it to us by email to worldmusic@xtra.co.nz
or post it to World Music Academy, PO Box 13-782 Johnsonville, Wellington.

If you require assistance please contact us.

Student’s name _______________________________________________________________
Home address _______________________________________________________________
Contact Phones _______________________________________________________________
E-mail address _______________________________________________________________
Date of birth _______________________________________________________________
Instrument owned _______________________________________________________________
Previous musical background _______________________________________________________________
Interest & Hobbies _______________________________________________________________
Parent’s contact details (Name) _______________________________________________________________
Parent’s contact phones (work, mobile) _______________________________________________________________


All information will be strictly confidential according to privacy act.

I ____________________have read the policy statement and fully understand the terms and conditions of the contract.


___________________( signature of student )


___________________( signature of parent )

Date _____________________

Lesson time _________________________

Lessons commences on ________________
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