www.lmjmusic.com                                                               Lisa M. Jones B.F.A.

                                                                                      Scarborough and Kawartha Lakes ON


All fees must be prepaid in full upon registration in order to secure a lesson time.  

Missed lessons can not be refunded.  In the case of withdrawals, there is a $30 administrative

fee plus the pro-rated amount for any classes that have taken place up to the time written

notification is received. No refunds will be issued after the 2nd class. If a class is cancelled due

to insufficient enrolment, there will be a full refund. Children (siblings, friends) who are NOT

registered for the program are not permitted to attend without permission.

No food, shoes, or drinks in the studio.  Bottles and sippy cups are ok!

 Parent/Guardian’s Name:____________________________E-mail_______________________


Child’s Name: ___________________________________________________________


Child’s Date of Birth: ______________________________________   Age:___________

                                       (Month, Day, Year)


Address: _________________________________________________________________

                   Number                               Street



                   City                                              Postal Code


Telephone: ______________________________________________________________

                               Home                                 Business                                 Cell


Lesson Day and Time: ___________________________________________________


Medical Information: ______________________________________________________

                                     (please list any allergies, medical conditions or special needs)


____yes ____no   L.M.J. Music and Lisa M. Jones has my permission to publish my child’s photo in

L.M.J. Music promotional materials/and or the L.M.J. Music website/Facebook page.


Method of Payment:    Cash___________      Etransfer___________


Total Fee:     $ _______________

 Waiver: In case of emergency, I authorize Lisa M. Jones to obtain medical attention. 

I release Lisa M. Jones, teachers and staff of all liabilities in case of accident or injury. 

I certify that all of the information listed on this registration form is complete and accurate. 

I have been provided with a copy of all Lisa M. Jones policies, and accept and agree to these policies.


Date: _______________ Signature: _________________________________