Instrumental Music Application

Cocurricular Music Application - New Student

Student Name*

First Name

Last Name

Year Level*

Date student will commence at Imnmanuel*

Parent/Guardian Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

Postcode

Mobile Phone*

Home Phone

Email*

Has the student received prior instruction on this instrument?*

What type of lesson would you prefer?*

Does the student intend entering for examinations?*

Are you able to provide your own instrument?*

Do you wish to add any other information?