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2A Commercial City

Corner Tungsten & Malibongwe Drive
Strijdom Park enrolmentform 2019
073 702 6971 / 011 792 8272
paulmusicacademy@outlook.com
Please tick your preferred disciplines:
Guitar Piano Bass Drums Vocals
Applicant details:
Title: __________ ID no. _______________________________________
Name: __________________________ Surname: ___________________________________
Date of Birth: _____/______/______ Email: ______________________________________
Cell: _____________________ Work: _____________________ Home: _______________________

Parent\Guardian details (if applicant is under 18 years of age) :

Relationship with applicant: ____________________________________________________________

Title: __________
Name: ___________________________ Surname: ____________________________________
Date of Birth: _____/______/______ Email: _____________________________________
Cell: _____________________ Work: ______________________ Home: _______________________
I.D no: ____________________________________
Next of Kin: ____________________________ Tel: __________________ Cell: __________________

Terms and Conditions

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1. Academy lessons begin on the 5th January 2018 and end on the 21 December 2019.
2. Students are required to attend one lesson per week at a scheduled date and time agreed by both the teacher and
student.
3. Upon enrolment, an annual registration fee of R250 (two hundred and fifty rands) is payable either by way of cash or
EFT (banking details supplied on request, of which proof of payment must be submitted upon enrolment).
4. Lesson are charged at R150 (one hundred and fifty Rands) for 30 mins. R300 (three hundred Rands) for 60mins.
5. Payments for lessons are to be made on a MONTHLY basis PRIOR to the first lesson of the month.
6. The Academy will NOT be held responsible for lessons not attended by students. These lessons are
NON REFUNDABLE. Lessons missed by students can be rescheduled only twice per year*.
7. Early termination of this agreement will be done by signing an Agreement Termination Form. ONE MONTH’S NOTICE
is payable on early termination of this agreement.

Agreement

I, ___________________________________ the Student/Parent, have read the terms and conditions and hereby accept
this agreement with Paul Music Academy for the year 2019 from application date below. I agree to pay the once-off
registration fee of R250 (two hundred and fifty rands) for 2019.

I hereby confirm that I have read and understand the content of the letter and confirm by signature hereunder that I
accept all the terms set out herein above and that my acceptance has been made freely and voluntarily.


______________________ _______________________ ___________________
Student Signature Parent/Guardian Signature Date
Emergencydetails

Emergency phone numbers:
1. Name of Contact: _____________________________ Phone no. :___________________________
2. Name of Contact: _____________________________ Phone no. :___________________________
3. Name of Contact: _____________________________ Phone no. :___________________________

Chronic illnesses/ Allergies/ Important Conditions (if any):
1. ____________________________________
2. ____________________________________
3. ____________________________________
4. ____________________________________
5. ____________________________________

Important Medication that may be needed (such as an inhaler or insulin pen):
1. ____________________________________
2. ____________________________________
3. ____________________________________
4. ____________________________________
5. ____________________________________

Notes ( Please indicate your 3 best and most available times for lessons here!)

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Bankingdetails
Payment Terms:
The registration fee must be paid before the very first lesson.
Monthly payments are to be made before the first lesson of the month.
Please use account name and statement no. at the top right of statement document
as a reference for payment.

Please make payments to:
Paul Music Academy
Standard Bank of SA Ltd
Branch Name: Northgate
Branch Code: 018505
Account No. : 1010 5686 571
Swift Code: SBZAZAJJ

For any queries feel free to contact us (during office hours):
Call : 073 702 6971 / 011 792 8272
Email: paulmusicacademy@outlook.com