Student Information

Student’s Name and Surname *

Student’s Cell Number *

Student’s Birthdate *

Student’s preferred language of instruction: *
 Afrikaans
 English

Student Type *
 Scholar
 Adult

If student is a scholar, please indicate Grade and School Name where scholar attends

Class Information

Class(es) Registered for: *
 Registration Fee: R250 once-off
 Scholar Piano: R550 per month / R1,650 per term
 Adult Beginner Piano: R650 per month / R1,950 per term
 Adult Worship Piano: R650 per month / R1,950 per term
 Scholar Violin: R550 per month / R1,650 per term
 Adult Violin: R650 per month / R1,950 per term
 Transport: R100 per month / R300 per term

Select possible suitable timeslots for the days below:

Tuesday Timeslots available
 14:20
 15:00
 15:40
 16:20
 17:00
 18:00 (only available to Adult Worship Piano Class)

Wednesday Timeslots available
 14:20
 15:00
 15:40
 16:20
 17:00

Thursday Timeslots available
 14:20
 15:00
 15:40
 16:20
 17:00
 18:00 (only available to Adult Beginner Class)

If none of the above timeslots are suitable, please type a day and timeslot between 8:00 and 12:00

Payment Information:

Select Preferred Payment option *
 Per Month
 Per Term

Payer Name and Surname (person responsible for payment and communication) *

Payer Email *

Payer Cell number *

Payer Physical Address *

Declaration and Undertaking

I commit to making payments faithfully as required by the chosen option above. I understand and agree that should a student want to cancel their enrollment, a written notice and payable notice period of two months is required. I understand and agree that all fees are non-refundable and that I do not receive a refund if the student ceases attendance or misses classes. I understand and agree that because classes are attended in groups, classes that are missed by students are forfeited and cannot be rescheduled. I understand that a once-off registration fee applies when a student enrolls at Stassenheim Music. This fee is to reserve a time-slot and is payable before classes can commence. I understand that there are 2 options available for payment: Monthly or per Term (3 months in advance). I understand that monthly class fees are payable over 12 months in advance before the 5th of each month. Class fees per term are paid in advance before the start of each school term. I understand that classes can only be attended if all fees were received.

Acceptance (required to complete registration) *
 I hereby accept and prescribe to the terms and conditions as determined by Stassenheim Music and agree to abide by them.