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Registration

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Contact Information
Your Name (Parent or Guardian)
First Last
Address
Street Address City Postal Code
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
- On-Line Lessons
- At School Lessons
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
For school lessons only Piano, Guitar & Ukulele are available.
School
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
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
For school lessons only Piano, Guitar & Ukulele are available.
School
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
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
For school lessons only Piano, Guitar & Ukulele are available.
School
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
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
For school lessons only Piano, Guitar & Ukulele are available.
School
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
2nd Choice
- In-Home Lessons
- On-Line Lessons
- At School Lessons
For school lessons only Piano, Guitar & Ukulele are available.
School
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
- Cheque
- Credit Card
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

Contact Us

Address: 109 Greendell Ave, Winnipeg, MB R2M 2R2, Canada

Phone: +1 (204) 786-1704

Email: info@academymusic.ca

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