Enrolment Form – Single Form One Student Details Terms & Conditions Student Name* First Last Parent's Name* First Last Address* Street Address City ZIP / Postal Code Primary Contact Number*MobileWork or home.Email* Students Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Experience Level*BeginnerIntermediateAdvancedMUSIC LESSON*Adults Can Rock (16+)Kids Can Rock 4 to 7Kids Can Rock 8 to 11Teens Can Rock 12 to 16Band WorkshopGroup GuitarPrivate GuitarGroup DrumsPrivate DrumsGroup VocalsGroup Singing - "Sing Stars" (5-7yrs)Private VocalsPrivate Bass GuitarEncore On KeysGroup Piano/KeyboardPrivate Piano/KeyboardGroup Theatre Works (Drama)Private Theatre Works (Drama)Group UkulelePrivate UkulelePrivate ViolinPrivate ClarinetPrivate SaxophoneUrban ChoirGROUP: Small groups of up to 4 students depending on instrument. PRIVATE: Exclusive One-on-One Tuition.GIFT VOUCHERS - ALL INSTRUMENTSNot a Gift VoucherGift Package One ($99)Gift Package Two ($140)Holiday Lesson Package One ($99)Holiday Lesson Package Two ($140)Select this option if you wish to purchase a Gift Voucher.My preferred days for lessons;* Monday Tuesday Wednesday Thursday Friday Saturday Everyday Please enter in your prefered time ranges. For example 3.30 to 4.30pm Monday, 4.30 to 6.30 Tuesday, etc*Please Indicate Any Learning Needs, Allergies or Social Needs*How Did You Hear About Us*Facebook Social PageRock n Roll High Facebook AdGoogleOther Search EngineNewspaperWord Of MouthReturning StudentWalk ByTerms and Conditions Please carefully read the following: -Rock 'n Roll High Terms and Conditions 2015- 1) Please be sure to be on time & make every lesson as RnRH is unable to offer free make up lessons for any lessons missed by you. 2) There are no credits or refunds for missed lessons. If your tutor is unable to make a lesson a substitute tutor will be available or a make up lesson will be made at a time suitable to you if however you miss this lesson we are unable to make the lesson up again. 3) Lessons are non transferable & non refundable. If lessons are terminated you may be charged a 50% penalty. 4) Rock n Roll High reserves the right to charge all overdue fee's to the credit card you enrol with if payment has not been made by the due date unless a payment plan is in place. Thank you for taking the time to read our terms and conditions.I Agree to the Terms and Conditions* I Agree Promotional Material* Yes please send me promotional email No thank you I do not wish to receive promotional material Rock 'n Roll School would like to send their clients occasional promotional material generally in the form of News Items, Summer School, New Courses and Programs, Specials etc. We understand that your inbox is probably flooded with spammers but if you would like to keep up with what we're doing please indicate in the check boxes above. Thank you for your considerationPhoto/Video Disclaimer. Please indicate that you have read the disclaimer on the enrolment page.* I have read and understand the exclusions relating to Photocopying material. I have Read and Understood my tutor will not be giving me any photocopied material as per our terms and conditions.CaptchaEmailThis field is for validation purposes and should be left unchanged.