Lesson Agreement

Once you have read the lesson agreement that was sent to you with a link to this page, please complete the form below.

Once you have completed this form you will be redirected to our GoCardless page where you will be able to setup the monthly direct debit.

Declarations

I consent to The Music Den Ltd collecting the information contained in this form.

I consent to The Music Den Ltd using images and videos of my child to use on social media and other marketing mediums. We will always communicate with you for permission before posting anything relating to your child. (Not required).

By signing the agreement I acknowledge that I have read and understood the points laid out in this agreement and have retained a copy for my records.

Are you? *

PARENT GUARDIAN STUDENT OTHER

Signature

Signature Consent

By entering you name in the above box you are accepting the above declarations and lesson agreement. You can cancel by exiting this page before submitting this form.

Signature date

Student's Name

Student's DOB

Your First Name

Your Surname

Your Address

Email Address

Phone Number

Emergency Number

Lesson Agreement

Once you have read the lesson agreement that was sent to you with a link to this page, please complete the form below.

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