SURNAME: ________________________________________ FIRST NAME: __________________________

Parent name/s: _________________________________________________________________________

ADDRESS: ______________________________________________________________________________

PHONE: (Home): __________________ (Business): __________________ Mobile: __________________

NAME OF SCHOOL (If student):_____________________________________________________________

EMERGENCY CONTACT: _________________________________________Phone No. ________________

EMAIL ADDRESS: _________________________________________________________________________

Preferred time to be contacted (if required): ________________________________________________

DATE OF BIRTH  ____________________________________     CURRENT AGE _____________________

DAY:         [_] TUESDAY 4:00PM~4:30PM( for Begs)         [_] TUESDAY 4:30PM~5:15PM (for Intermediate /Adv) 

                                                Private Lessons available after classes  ..           

TIMES –   Private lessons will be available before and after classes by appointment. Please contact Chris for your preferred Day and Time

TIME:  Please indicate if you have a preferred time: __________________________________________

_______________________________________________________________________________________

2^ND PREFERENCE: ________________________________________________________________________

_______________________________________________________________________________________

Note – additional days /times may be available, subject to availability.   

PLEASE  RETURN THIS FORM TO CHRIS TREGONNING EITHER VIA EMAIL (christreg@netspace.net.au) or P.O BOX 489 , BERWICK 3806 AND WE WILL CONFIRM YOUR POSITION AS SOON AS POSSIBLE..