(All information provided will be kept confidential)
New Student Name: *
Age and date of birth: *
Please give name of person who would be paying for the music lessons (parent name /self): *
Telephone Number: *
Instrument or lessons required: *
Level required: *	Beginner Intermediate Advanced Exam stream Music 'just for fun'
Best location (Trenton, Frankford or Stirling): *	Trenton Frankford Stirling Trenton or Frankford Frankford or Stirling Trenton, Frankford or Stirling
What music tuition are you looking for?: *	Individual, private music lessons Group lessons ('Go MAD!' for Music, Art, Drama) Guitar 101, Photography 101, Art 101 Singing Musical Theatre, Drama Theatre Guitar Rock Camp Worship Guitar Sunday Jammin' (for other, specify below)*
Other (*)
Is anyone in your family currently taking lessons with us at any location at RiverSide Music: *	Yes No
Specific Teacher requested (if known):
Best Days of the week that you would like music lessons (OPEN 7 days a week for lessons): *
Best Times (10am to 9pm; up to 5pm weekends): *
Special Needs or Requirements: *	No Yes - please contact me to discuss
Email address:
How did you hear about us?:	Recommendation from friend or family member Yellow Pages Local Newspaper Advert Flyer Radio Walked into store Internet search
Interested in other Groups?:	String Orchestra Tai Chi, etc.
When signed up, please tell us who recommended us to you so we can give them 'our special thanks'