Enrol Now !

Please complete this form to enrol yourself or your child with East Coast Music for piano lessons.

Are you enrolling yourself or your child?*
- Myself (adult)
- My child
Preferred Location*
- Alexandra HIlls
- Tweed Heads South
Your name*
Prefix First Last
Your child's name*
First Last
Your child's date of birth*

Day
Month
Year
Other Parent or Guardian' Names*
Please type the full names of the child's other parent or guardians
Address
Street Address Address Line 2 Suburb State Postcode
Email*
Preferred Phone Number*
Alternate Phone Number
Carer Name and Contact*
Contact details of person bringing child to class if different from above.
Emergency name and contact numbers*
We must have a contact name and number for emergencies.
Special needs or allergies
Please let us know if your child has special needs or allergies
Comments
Payment*
Payment of Term fees by cash, cheque or electronic transfer must be made in full prior to the commencement of term.
For payment by cheque, make payments to East Coast Music.
We will send you an invoice with our Bank Account details for Direct Debit or Bank Transfer.
We will send you a Direct Debit form for instalments through Ezidebit®. Additional fees will apply.
How did you hear of us?
Receive
- e-Newsletter (quarterly)
Anti-spam check
Phone
This field is for validation purposes and should be left unchanged.

Simply Music Piano lessons Brisbane Bayside & Tweed Heads South