06 November 2018
Medical: Do you have any medical conditions (Eg Epilepsy, Asthma, ADD, Diabetes)
that we should know about?
Year of Birth
Enter the times or time ranges that you are available for that day. Example 9:30am
Enter the times or time ranges that you are available for that day. Example 3:30pm
I give my consent to be contacted by Access Music by SMS.
I have read, understood and agree to abide by all above terms and conditions.
Relationship to the Student:
Student or Guardian Name:
Credit card Number:
Please deduct my
I am paying $350 inclusive of GST for 10 Individual Lessons as per conditions above.
Conditions of Application
1- Applicants are required to pay for the full term tuition prior to commencement
of the term.
2- Fees are non-refundable once the applicant an us have agreed to a designated time
and day to undertake lessons.
3- Applicants are responsible for attending weekly tuitions. In circumstances where
this is not possible, please notify the academy within a reasonable timeframe (usually
4- Applicants undertaking individual tuition are eligible to arrange with their teachers
ONE alternative (“make up”) lesson. Any further alternative arrangements are completely
at the teacher’s discretion. Access Music Willetton is under no obligation to provide
more than ONE alternative (“make up”) lesson.
5- Any changes to tuition times are to be made with the Administration of Access
6- Access Music Willetton reserves the right to terminate this contract at any time.
To submit this Application you need to pay for a minimum of 10 Lessons.