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Registration form Key4Music

Please fill in all fields.

Personal data

First name / family name pupil *

Address *

Postal code *

Residence *

Mobile number parents *

Mobile number pupil

Email address parents *

Email address pupil

Date of birth *

Registers for instrument / vocals / musicproduction

Please make a choice * Private lessons weekly Duo lesson weekly Private lessons 1x per 14 days (possibility from 12 years of age in consultation) 10-lesson card Junior kids music lessons (4-6 years old) Allround kids music lessons (6-8 years old) Bandcoaching Vocalgroup Preliminary training conservatory / rockacademy Others (please give explanation in field “remarks”)

Which lesson? Instrument, please mention which instrument in field “remarks” Vocals Musicproduction or other course Welke cursus of groepsles

Remarks

Undersigned agrees to the General Conditions and authorizes Key4Music to collect periodic tuition fees until further notice.

Authorization

I authorize Key4Music to collect periodic tuition fees from my bank-account until further notice.

Name account holder *

IBAN bank-account number *

I choose for payment Lump sum (2% discount) * 2 terms in consultation Monthly payments (only possible from at least 19 lessons)

* Discount only applies to 38 regular weekly lessons (full schoolyear)

How did you find Key4Music? Word of mouth Flyer Social media Website / google Newspaper advertisement Others

In case of others:

I agree to the algemene-voorwaarden

I agree to the fact that Key4Music uses foto- or videomaterial of shows or from lessons on social media Yes No

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