Download 10 am to 1 pm MUSIC BONANZA! 1 pm to 4 pm PIANOS

APPLICATION FORM : SCHOOL HOLIDAY PROGRAMS – 10 JULY 2015
Please print this form, complete and sign it and return this by post to:
CHARTERIS MUSIC SCHOOL, PO BOX 1398, CAMBERWELL, VIC 3124.
10 am to 1 pm
MUSIC BONANZA!
Want to make some noise? Want to make some music? Come
sing and jam with us! This exciting program offers a range of
enjoyable musical activities to suit ages 4 - 12 years old.
1 pm to 4 pm
PIANOS, KEYBOARDS AND MORE!
Is piano/keyboard your instrument? If you're a beginner, come
and find out for yourself! If you already play the
piano/keyboard, come and jam with us. Offering a range of fun
keyboard-theme activities, this suits absolute beginners to
Grade 3 AMEB.
Location : Camberwell Uniting Church, 314 Camberwell Road, Vic 3124.
PLEASE SELECT PROGRAM [by ticking √]
Music Bonanza! AND Pianos, Keyboards & More!
Music Bonanza!
Pianos, Keyboards & More!
Fri 10 Jul 2015, 10 am to 4 pm (Whole Day)
Fri 10 Jul 2015, 10 am to 1 pm (Morning)
Fri 10 Jul 2015, 1 pm to 4 pm (Afternoon)
STUDENT Surname: ________________
Given Name: _________________________________
Male / Female
Date of Birth: ________/_________/______________
IS THERE ANY MEDICAL CONDITION OR OTHER CIRCUMSTANCE OF WHICH YOU WOULD LIKE THE SCHOOL TO BE
AWARE?
Yes
No
If Yes, please give details here:
PARENT/GUARDIAN:
Surname: _____________________________
Given Name: _________________________________
Address: ____________________________________________________________________________
Suburb: ______________________________ Postcode: ___________________________________
Landline phone: _______________________ Mobile Phone: ________________________________
Email address: _______________________________________________________________________
Where did you hear about us? __________________________________________________________
Terms and Conditions:
1. I, the parent/guardian, understand that places are limited. In the event the holiday program is over-subscribed, I have the option of placing my child on
Charteris Music School's waiting list or ask for my deposit to be returned in full.
2. NUT-FREE POLICY - Charteris Music School has a nut-free policy. Students are asked not to bring any food containing nut products to classes and concerts.
3. I, the parent/guardian, am required to inform Charteris Music School in writing of any allergies my child may have.
4. Balance is due no later than first day of holiday program. The student will not be able to start the holiday program until full balance is received by Charteris
Music School.
5. Where it is impractical to communicate with me, I, the parent/guardian, authorise the staff of Charteris Music School to whatever medical or surgical
treatment as may be deemed necessary for my child.
6. Charteris Music School accepts no liability or responsibility for any injury sustained by the student that arises from participation in any activity connected with
Charteris Music School.
7. I, the parent/guardian, authorise Charteris Music School to use photographs/videos taken during classes/concerts for promotional use only.
8. If the student cancels and this cancellation is received by Charteris Music School prior to the commencement of the holiday program, Charteris Music School
reserves the right to try to fill this spot with a new student at their discretion. If this place is filled with a new student prior to the commencement of the
holiday program, Charteris Music School will refund the balance of the deposit minus a non-refundable $20 administration fee. This administration fee is nonrefundable under any circumstance. If the student cancels and this cancellation is received by Charteris Music School prior to the commencement of the
holiday program, but Charteris Music School is unable to find a new student to fill this position, then the deposit is forfeited.
9. If a deposit only has been paid, then the balance is due (in cash) no later than the first day of the holiday program.
10. There is no refund of deposit or balance once the holiday program has commenced.
11. I, the parent/guardian, understand that Charteris Music School reserves the right to cancel classes that do not meet the enrolment quota. In this case, a full
refund will be returned to me.
12. I understand that Charteris Music School reserves the right to exclude students whose behaviour is disruptive.
13. Enrolment and/or attendance at Charteris Music School constitutes acceptance of the above terms and conditions.
I WOULD LIKE TO PAY THIS AMOUNT NOW:
NO. OF CHILDREN
ATTENDING
AMOUNT
EFT Deposit of $49 per child for ‘Music Bonanza!’ And 'Pianos,
Keyboards & More!' (Balance to be paid by cash only on the day
of Holiday Program)
OR
EFT Deposit of $25 per child for ‘Music Bonanza!’
(Balance to be paid by cash only on the day of Holiday Program)
OR
EFT Deposit of $25 per child for 'Pianos, Keyboards & More!'
(Balance to be paid by cash only on the day of Holiday Program)
OR
EFT Full Fee of $99 per child for ‘Music Bonanza!’ And ‘Pianos,
Keyboards & More!’ (save $11!)
OR
EFT Full fee of $55 per child for ‘Music Bonanza!’
OR
EFT Full fee of $55 per child for ‘Pianos, Keyboards & More!’
TOTAL PAID BY EFT
I have already paid this amount by EFT to the account below
Direct Deposit (EFT) Details:
Account Name: Charteris Music School
Bank: ANZ
BSB: 013247
(Please include your and your child's names as reference)
Account Number: 266545286
I give permission for my child to participate in this School Holiday Program. I understand the Terms and Conditions and
agree to abide by them.
_____________________
Signature
_____________________
Name (please print)
________/_________/__________
Date (day/month/year)
OFFICE USE ONLY
Date received:
Place offered: Y / N
Entered into enrolment / waiting list: Y / N
Deposit/Received: Y / N
Enrolment confirmed with parent/guardian: Y / N
Entered into Database: Y / N
Special Notes: