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

                                                                                                 Scarborough, ON

REGISTRATION FORM

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.

 

Method of Payment:    Cash___________     Cheque______________

                                                      (Please make cheque payable to L. M. Jones)

 

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: _________________________________