Enrolment Form

Piano and Organ Application Form
Please fill out this form to apply:
   
  
DATE OF BIRTH*:             AGE:             GENDER:
NAME OF PARENTS*  (First Parent)     (Second Parent)
:
:

   


   

Preferred method of payment (choose from one of the following 3 options):

Preferred method of payment is EFT. Account name: Dorothy Di Lullo BSB: 063027 Account No: 10024721. Please be sure to put your name in the description and print a copy as a receipt. Cheques/Money orders payable to Dorothy Di Lullo.

TERMS OF ACCEPTANCE

By submitting this form, we:

  1. Hereby release and agree to indemnify and hold harmless Kindermusik by Piano & Organ School of Music, its educators, employees, liabilities, costs and expenses including solicitor's fees which they or any of them or my child may sustain or incur in any way arising out of my child's participation in any and all Kindermusik by Piano &Organ School of Music activities.
  2. Have read and agree with the Registration policy.

TYPE ANTI-SPAM CODE

Please type in the correct code as you see it otherwise submission of this form will fail. If the code is not clearly visible, press the 'GET A NEW CHALLENGE' icon indicated by the two revolving arrows above.

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