Registration - Portage Conservatory of Music

Student Name *

First

Last

Date of Birth *

yyyy-mm-dd

Gender

female
male

School attended (if applicable)

Instrument

Drums/Percussion
Guitar
Piano

Parent Name

First

Last

required if student is under 18

Primary Phone Number *

(204) 123-4567

Primary Phone Type

primary phone type

Email *

Confirm Email

Address *

Line 1

Address

Line 2

City or Town *

Postal Code

A1A-1A1

Other Phone Number *

e.g. cell, work

Other phone type

other phone type

Additional Information

e.g. questions, availability for scheduling

Student Agreement *

I have read and I understand the terms of the Student Agreement *

By attending lessons with instructors of Portage Conservatory of Music, the student (or parent/guardian, when applicable) agrees to the following conditions:
There is a $25.00 annual registration fee. A lesson time will not be held without payment of the registration fee.
All music fees are due in advance for each term or month regardless of lessons missed.
Post dated cheques are to be dated for the first of the month.
Refunds will not be issued for lessons missed by the student.
Non-sufficient-funds (NSF) cheques will be subject to a $10 service charge.
The student/parent or guardian will give sufficient notice to Portage Conservatory of Music regarding missed lessons. Sufficient notice is a message to Portage Conservatory of Music (857 4218) by noon (12pm) for all lessons beginning 4pm and later, and by the previous evening (by 9pm the night before) for any earlier lessons.
Missed lessons due to vacations, sports games, school dances, shopping trips, etc. will not be rescheduled.
In case of withdrawing from the program, written notice must be given (email or letter) 30 days in advance of the date of the final lesson. Lesson payments must by made until the end of the 30 day withdrawal period, whether the lessons are attended or not.

Group Lessons:
Refunds will not be issued for lessons missed by the student.
There will be no make up lessons for lessons missed by the student, with the exception of lessons cancelled or rescheduled by the teacher.

Private Lessons:
There will be no make up lessons for lessons missed by the student, with the exception of lessons missed because of sickness or storm. (Up to a maximum of 4 lessons per year.)
All rescheduling of missed lessons will be subject to teacher availability.
Failure to abide by the above terms may result in forfeited lessons and possibly immediate termination of lessons subject to a penalty of one month’s lesson fees.

The terms of this agreement may be altered by the Management or Director of Portage Conservatory of Music, in which case a notice of such changes will be made available to students and parents/guardians.

Name