Nursery Notes

Enrolment Form

STUDENT DETAILS

First Name:

Last Name:

Date of Birth:

Age:

Nursery Notes Class Location:

Class/Room Name:

Year:

Attendance Days (Please tick):

Mon

Tue

Wed

Thu

Fri

PARENT/GUARDIAN DETAILS

First Name:

Last Name:

Relationship:

Contact: (W)

(H)

(Mob)

Address:

Email Address:

MUSIC DETAILS

Instruments Played at Home or by a Family member: (Please Tick)

Piano/Keyboard	Trumpet	Violin
Saxaphone	Clarinet	Recorder
Guitar	Flute	Other

STUDIO CLASSES ONLY

Please select all available times, as classes fill up quickly. All classes run for 30 mins: (Please Tick)

MON

1:10pm

1:45pm

2:20pm

3:20pm

3:55pm

4:30pm

TUE

1:10pm

1:45pm

2:20pm

3:20pm

3:55pm

4:30pm

WED

1:10pm

1:45pm

2:20pm

3:20pm

3:55pm

4:30pm

THU

1:10pm

1:45pm

2:20pm

3:20pm

3:55pm

4:30pm

FRI

1:10pm

1:45pm

2:20pm

3:20pm

3:55pm

4:30pm

HOW DID YOU HEAR ABOUT US?

How did you hear about Nursery Notes ?: (Please Tick)

Google	Kidspot	Referred By
Canberra Kids	Canberra Times	Other
Newspaper

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