Kirtan/Music Classes - Enrollment Form

Kirtan/Music Classes – Enrollment Form

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Enrollment Request Form

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Step 1

Student Name *

Gender

Date of Birth

Occupation

Address

Phone Number

Email

Please advise of illness or medical condition (if any)

About Your Course

In this section, please mentioned the course/instrument you are interested in and the preferred Day and Time you would like to attend the class.

I am interested in learning:
HarmoniumTablaString Instrument
I would like to start from:
Select the level from where you would like to start your learning for the above selected course(s)
I would preferred to join: *
Fee for Group Class $50 per student per month, Individual Class - $100 per month. For further details on class please visit: Gurmat Sangeet Academy – Rules and GuidelinesGroup ClassIndividual Class
My preferred day & time of my classes are:
You can mention more than one timings as per your preference order. Eg: TABLA - Group Class - Wednesday 11:00 AM
I would like to start this course from:
PS: Do NOT answer this question if you want to start on the first date/time available (as per your preferred time)
Any special request/concern

Emergency Contact Information

Emergency Contact Name
Relation with the applicant
Emergency Contact Number
Emergency Contact Address
Same as student's addressOther
Emergency Contact Email Address

Kirtan/Music Classes – Enrollment Form