Registration 2012 2013 by F6yLEoY


									                                                                                 Office #250-860-1737
                                                                                 Teachers message line #250-762-0762
                                                                                 728 Dehart Ave, Kelowna, BC V1Y 6A1

                                                                       2012/2013 Registration Form
Contact/Parent First Name                                                                         Last Name

Student’s First Name                                                 Last Name                                                Date of Birth

Street Address                                                       City                                                     Postal Code

Home Phone                           Work Phone                      Cell Phone                         Email

If the student has a medical condition we need to be aware of please explain:

I give permission to KCMS to use pictures of the student for promotional material. Yes                                                      No
Returning __New__Where did you hear about KCMS?
KCMS will use the above information for registration and communication purposes only and will not share it with anyone.

Instrument/Voice                Teacher            Grade       Lesson Day Lesson                    Date /First      Date/Last            Total # of
                                                   Level       & Time     Length                    Lesson           Lesson               Weeks

Theoretical Subjects
(Recommended in Gr 4.
 and up)


Registration Policies:
   Each registration has a non refundable registration fee of $50.00 for individuals or $80.00 per family for private lessons or $20 for group ensembles
    which is due upon registration. Pre-registration is due prior to June 30th to reserve your spot for the Fall.
   Fees for private lessons may be divided into 9 equal payments payable the 1st of the month Sept. through May
   Fees for groups/ensembles can be split into two payments, Sept 1 and December 1.
   There is a $25 charge for NSF cheques
   Four (regular lesson) weeks written notice is required for withdrawal from private lessons. No withdrawals accepted after March 15
   No refunds on group lessons or ensembles
   Please refer to the attached Welcome Letter for full rules and regulations.
I have read, understand and agree to the registration policies.

Signature: ____________________________________                            Date: _______________

Registration is not complete until registration fee and post dated cheques are received

Office Use only              Reg. Rec’d                Post Dated Rec’d          Entered Simply           Entered Data             File

Total # of Weeks             X Fee                     Sub Total $               Reg Fee                  Total $

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