Music Lesson Registration Form

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Registration Requirements:

Your child must live between Jarvis St. to Broadview Ave. and Wellesley St. to Lake Ontario, and meet the age requirement for the instrument.
Within the first year of lessons, students may enroll in only one subject. Please note that there is a waitlist for some instruments.
Once offered a time slot, we require families to provide proof of income (monthly gross income from all sources) to determine the cost of lessons. Returning families must provide this information annually for each new school year in September. Tax statements are acceptable. All of your information is kept confidential.

You will have the option to enroll up to four children in Dixon Hall Music School. If you are enrolling more than one child, after completing all information for your first child, please hit the NEXT button to proceed with the registration process for your next child. Once you have inputted all your children’s information, please hit the submit button on the last page.

Parent/ Guardian Information

Parent/Guardian #1*

First Name*

Last Name*

Parent/Guardian #2

First Name

Last Name

Address*

City*

Postal Code*

Primary Phone*

Secondary Phone

Email address*

Note: Bills will be sent electronically to your email address if provided.

Preferred Method of Contact*

Phone

Both

# of children in your household and their ages (including those not enrolling):*

Language(s) spoken at home*

How did you hear about Dixon Hall Music School?

Do you give Dixon Hall permission to use photos/videos of your children for promotional purposes?*

Yes

How many children are you enrolling in Dixon Hall Music School?

Lesson Fees & Payments

All lesson fees are subsidized and are based on family income and the number of dependents. Upon registration, families will be required to provide an up to date proof of income from all sources to determine lesson rates. This information will be kept confidential.

Child #1

First Name

Last Name

Gender

Optional to provide pronouns: She/Her, He/Him, They/Them, etc.

Age

Birthday*

Student Phone

Student Email Address

Instrument (1st Choice):

Instrument (2st Choice):

Check one:

I need to rent an instrument

I own my own instrument

I currently rent an instrument

Does your child take music lessons currently, or has studied music in the past? If yes, where and for which instrument?

Does your child have any medical (allergies, etc) or mental health conditions, and/or learning disabilities that we may benefit from knowing?

Child #2

First Name

Last Name

Gender

Optional to provide pronouns: She/Her, He/Him, They/Them, etc.

Age

Birthday*

Student Phone

Student Email Address

Instrument (1st Choice):

Instrument (2st Choice):

Check one:

I need to rent an instrument

I own my own instrument

I currently rent an instrument

Does your child take music lessons currently, or has studied music in the past? If yes, where and for which instrument?

Does your child have any medical (allergies, etc) or mental health conditions, and/or learning disabilities that we may benefit from knowing?

Child #3

First Name

Last Name

Gender

Optional to provide pronouns: She/Her, He/Him, They/Them, etc.

Age

Birthday*

Student Phone

Student Email Address

Instrument (1st Choice):

Instrument (2st Choice):

Check one:

I need to rent an instrument

I own my own instrument

I currently rent an instrument

Does your child take music lessons currently, or has studied music in the past? If yes, where and for which instrument?

Does your child have any medical (allergies, etc) or mental health conditions, and/or learning disabilities that we may benefit from knowing?

Child #4

First Name

Last Name

Gender

Optional to provide pronouns: She/Her, He/Him, They/Them, etc.

Age

Birthday*

Student Phone

Student Email Address

Instrument (1st Choice):

Instrument (2st Choice):

Check one:

I need to rent an instrument

I own my own instrument

I currently rent an instrument

Does your child take music lessons currently, or has studied music in the past? If yes, where and for which instrument?

Does your child have any medical (allergies, etc) or mental health conditions, and/or learning disabilities that we may benefit from knowing?

Submit

I agree to ensure my child(ren) are aware of their responsibilities as a student, and will practice regularly and attend all weekly lessons if accepted at Dixon Hall Music School.

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