Rock of Ages
Please note: Registration booking form and the fees must paid prior to beginning music sessions at ROA.

Choose an instrument *



Date of birth*


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*


Signature of Student or Parent/Guardian*