Enrolment form for Saturday Music classes 2017
Please fill out a separate enrolment form for each student and each class
Enrolment into Saturday Music indicates acceptance of the terms as specified in the 2017 handbook.
The handbook is available on the website www.saturdaymusic.org.nz or from the front desk on
Saturday mornings. All information on this enrolment form will remain confidential.
For Saturday Music use:
Time:
Room:
Tutor:
Receipt number:
Payment: cash/chq/int
INSTRUMENT / CLASS ENROLLING FOR (PLEASE CIRCLE ONE ONLY)
(Please note that for orchestra enrolments, a separate enrolment form will be available at the beginning of term 1).
Cello
Drums
French horn
Music Basics 1
Recorder
Trumpet
Choir
Fife
Guitar
Music Basics 2
Saxophone
Violin
Clarinet
Flute
Keyboard
Music Basics 3
Trombone
Has this student been enrolled in any Saturday Music classes before this year?
If yes, which year?
_______________________________ What instrument?
.....................................................
Yes / No
_________________________________
Is the student being enrolled for any other Saturday Music (PN) class? Yes / No: If so, which class?
___________________
CONTACT DETAILS
Student’s full name (underline family name)
Postal address
________________________________________________________________
________________________________________________________________________________________
E-mail address # 1
E-mail address # 2
Telephone number
Daytime ____________________
Student’s age as at 1 March 2017 (years and months):
Parent/caregiver’s name (underline family name)
Name of school which student will attend in 2017:
After hours _______________
Cellphone ________________
________________________________________________________
Dr / Mr / Mrs / Ms / Miss
____________________________________
___________________________________________________________
CLASS TIMES
Although parent/caregivers are asked to state their preferred lesson times, Saturday Music cannot guarantee that any
particular time that is so selected will be available. Once a class time has been allocated, it may not be possible to change
this time later in the year. Classes are 30 minutes long. The choir is held from 12.30 pm to 1.15 pm.
Preferred class times (please circle):
1st choice
2nd choice
8.30
8.30
9.00
9.00
9.30
9.30
10.15
10.15
10.45
10.45
11.15
11.15
anytime
anytime
If you are enrolling more than one child, would you prefer the classes to be (please circle):
at the same time
one after the other
either
completely different times
Are there any times your child cannot attend (please circle)
10.15
8.30
9.00
9.30
Does the student have any brothers/sisters who are also being enrolled for a Saturday Music class?
10.45
11.15
Yes / No
Name of brother/sister:
______________________________
Instrument/class:
________________________________
Name of brother/sister:
______________________________
Instrument/class:
_______________________________
MEDICAL ISSUES AND OTHER INFORMATION
Please list any medical issues or other information which Saturday Music should know about *: ________________________
_______________________________________________________________________________________________________
*
Please note that all information that will affect the student’s ability to participate fully in a class, and within a group
setting, must be disclosed (please see the Saturday Music policy at the bottom of page 3 in the handbook).
STUDENT’S MUSICAL EXPERIENCE – (FIRST TIME FAMILIES ONLY)
Please fill out this questionnaire if this is the first time the student has been enrolled in this class/instrument at
Saturday Music. This information will allow the Director to place the student in the correct class/level.
Has the student previously attended any Music Basics classes?
If so, which year did he/she attend?
...............................................................................
Yes / No
.....................................................................................................................
1/2/ 3
Has the student learned an instrument before?
........................................................................................................
Yes / No
If so, which instrument, and for how many years?
___________________________________________________________
List any other musical experience the student has:
___________________________________________________________
_______________________________________________________________________________________________________
How well is the student able to read music?
Can the student read any of the following?
.....................................
............................
Very well / Moderately well / Only a little / Not at all
Treble clef / Bass clef / TAB / Guitar chords / Drum notation
If the student is enrolling in a drum class, is he/she right handed or left handed?
....................................................
Students enrolling in a drum class must be at least 125 cm tall. Does your child meet this height requirement?
..
RH / LH
Yes / No
HOW TO ENROL
Students may enrol for the 2017 classes at any time between the 2016 open day (3 September 2016) and the final enrolment
day (18 February 2017). Please complete this enrolment form, include the subscription in full, and:



Present the completed form and subscription to the foyer of Palmerston North Intermediate Normal School during
Saturday Music (PN) lesson times; or
Present the form and subscription on the final enrolment day, Saturday 18 February 2017; or
Post the form and subscription (cheque* or internet banking details – please do not send cash by post) to:
The Treasurer Saturday Music, 20 Shamrock Street, Palmerston North
* Cheques should be made out to Saturday Music and crossed ‘not negotiable’.
Please note: Enrolments will be processed once subscriptions are paid in full.
SUBSCRIPTION PAYMENT DETAILS
Each subscription*
* A $5.00 discount on each subscription will apply if paid by 26 November 2016.
$115.00
Internet banking payments can be made to Saturday Music, bank account number 03 1522 0032434 00.
When paying by internet banking, a separate payment must be made for each child. Please enter the following details:
Particulars = telephone number; Code = class or choir or orchestra; Reference = child’s name
The enrolment form must still be posted to, or presented at, Saturday Music.
Method of payment (please circle one):
Amount of payment
............................
$ ____________________________
cash (not to be posted) / cheque (enclosed) / internet banking
Date of payment:
__________________________________
BEFORE YOU ENROL, PLEASE CHECK THAT:
a form has been filled out for each student and each class and all sections have been completed
the student has been enrolled for a class/instrument appropriate to his/her age
the correct subscription amount is being paid