Alexandrov Music Centre
7 - 3455 Garrard Road Whitby, ON L1R 2N2
Phone: 905-720-4948 info@alexandrovmusiccentre.com

Enrolment CONTACT FORM

STUDENT’S FIRST NAME
STUDENT’S LAST NAME
AGE
PARENT’S FIRST NAME
PARENT’S LAST NAME
HOME TELEPHONE
WORK TELEPHONE
E-MAIL
ADDRESS
IN WHAT PROGRAM / INSTRUMENT ARE YOU INTERESTED
DO YOU HAVE AN INSTRUMENT
HAVE YOU TAKEN LESSONS BEFORE
WHAT INSTRUMENT(S)
FOR HOW LONG
WHAT LEVEL COMPLETED
WHAT IS YOUR SPECIAL INTEREST IN MUSIC