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30th Anniversary Special

First Online Lesson

Registration

Step 1 of 7

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Contact Information
Your Name (Parent or Guardian)
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Email Address
Enter Email Confirm Email
Cell Phone
Home Phone
How many students are you registering?

Student #1
Name
First Last
Is the student an adult?
Date of Birth
Instrument*
1st Choice
- In-Home Lessons
- Online Lessons
- At School Lessons
- Studio Lessons
2nd Choice
- In-Home Lessons
- Online Lessons
- At School Lessons
- Studio Lessons
School (For school lessons - only Piano, Guitar & Ukulele are available)
Length
- 30 Minutes
- 45 Minutes
- 60 Minutes

Student #2
Name
First Last
Is the student an adult?
Date of Birth
Instrument*
1st Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
- Studio Lessons
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
- Studio Lessons
School (For school lessons - only Piano, Guitar & Ukulele are available)
Length
- 30 Minutes
- 45 Minutes
- 60 Minutes

Student #3
Name
First Last
Is the student an adult?
Date of Birth
Instrument*
1st Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
- Studio Lessons
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
- Studio Lessons
School (For school lessons - only Piano, Guitar & Ukulele are available)
Length
- 30 Minutes
- 45 Minutes
- 60 Minutes

Student #4
Name
First Last
Is the student an adult?
Date of Birth
Instrument*
1st Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
- Studio Lessons
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
- Studio Lessons
School (For school lessons - only Piano, Guitar & Ukulele are available)
Length
- 30 Minutes
- 45 Minutes
- 60 Minutes

Student #5
Name
First Last
Is the student an adult?
Date of Birth
Instrument*
1st Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
- Studio Lessons
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
- Studio Lessons
School (For school lessons - only Piano, Guitar & Ukulele are available)
Length
- 30 Minutes
- 45 Minutes
- 60 Minutes

How did you hear about us?
Please list all days and times that are possible for lessons:
Preferred Payment Method
- Credit Card
- E-transfer
Name on Credit Card:
Credit Card Number:
Expiry Date:
CC Disclaimer*
I understand that my credit card information will be used to securely provide payments to Academy of Music on a recurring monthly basis until the end of June within the current school year.I have read the Tuition and Policies
- Yes
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Us

Phone:

Toll Free: 1-866-502-0206
Local: +1 (204) 786-1704

Email: info@academymusic.ca

Locations

Brandon Music Lessons
Portage La Prairie Music Lessons
Steinbach Music Lessons
Thompson Music Lessons

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