New Student Registration — Vocals, Music & Confidence with MJ

New Student registration form

Hello friend,

Welcome! Whether you're here for Heart Notes music classes, vocal coaching, or mentoring sessions, I'm so glad you're here.

Please take a moment to fill out these questions so I can be all ready for you at our next session. You’ve taken a significant step to do something positive and special for yourself/your loved one, so well done & welcome aboard!

Student Name

First Name

Last Name

Name/s of siblings also attending (if applicable)

Student's Birthday (yes, there will be a birthday song!)

Parent Name(s) (if applicable)

Mobile Phone

Email Address

Would you like your lessons in person, or online?

Facebook Messenger/Skype name (for online students)

Student's musical background, if any

What kind of music does the student like?

How did you hear about me? E.g. Friend/Gumtree/Facebook/Other

Can I use photos of the student on my website/blog/Facebook page?

Yes

Maybe: ask first

Any relevant medical issues?

Emergency Contact & their relationship to student

Emergency Contact Phone No.

Date

I, the abovesigned, being aware of my own/my child's health and physical condition, and having knowledge that engaging in the physical & mental activity of singing comes with inherent risk, am voluntarily participating/allowing my child to participate in this activity. Having such knowledge, I hereby acknowledge this releases any representatives of Voice Coaching with MJ and Heart Notes from liability for accidental injury or illness which I may incur as a result of participating in the said physical & mental activity. I hereby assume all risks connected therewith and consent to participate in said program. I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in said program. I also consent to abide by the Terms and Conditions as detailed on this website.

Yes, I agree with this