Choose an instrument *
Name*
Address*
Date of birth*
Email*
Home Phone
Cell Phone*
How did you find out about us?*
Tell us what level of experience you have in your chosen music-making option*
Please summarise your experience
**The following MUST be completed if student is under 18
Emergency Contact Name*
Emergency Contact Phone*
This section is optional for students over 18, but recommended
Details of any medical conditions we should be aware of
What you need to bring to your lesson: Please note that we supply all instruments, headphones, and equipment. However, students are welcome to bring their own guitars, drumsticks, etc... Water is recommended for vocalists.
Terms of agreement: (by signing this form you agree to be bound by all of the following):
Payments: On joining Rock Of Ages, you agree that payments are to be made prior to any instruction. Ongoing payments are due the first of every month without exception.
Make-up classes: We regret we are unable to make–up same day missed lessons, however, if given 1 weeks’ advance notice, we will happily reschedule the student for a make-up class the same week.
Tutors: In the event of tutor illness/holidays you may sometimes be taught in larger groups than normal. We reserve the right to rotate and substitute tutors at our discretion.
Staff training: On occasions we may record lessons for staff training using audio/video methods.
Disclaimer for promotional Purposes: I understand that the picture and/or video taken at Rock of Ages Music School may be used for promotional purposes.
Are you 18+?
Name of Student or Parent/Guardian*
Date*
Signature of Student or Parent/Guardian*
