Kamloops Symphony Music School Registration Form

Please fill out the form below to register for private lessons or classes. If you would prefer filling out a digital copy, or printing it out, a pdf version of the form can be found here.

Please note that an additional form is required for those registering for MYC classes. Please contact the office at 250-372-5000 for more information.

Student Information

* Student's Name

* Date of Birth (e.g. March 7, 1997)

* Home/Primary Phone

Cell Phone

Work Phone

* Email

Mailing Address

* Street Address

* City

* Province

* Postal Code

* I would like to be added to the Kamloops Symphony E-Newsletter Mailing List Yes
No

Parent/Guardian Information

Parent/Guardian Name 1 (if applicable)

Mailing Address (If different from above)

Home/Primary Phone

Cell Phone

Work Phone

Parent/Guardian Name 2 (If applicable)

Mailing Address (if different from above)

Home/Primary Phone

Cell Phone

Work Phone

Lesson/Class Information

* Instrument or Class

Teacher

* New or Returning Student? New Student
Returning Student

Preferred Day

Preferred Time

Length of Lesson 30 minutes
45 minutes
60 minutes

Frequency Weekly
Bi-weekly

Instrument or Class

Teacher

New or Returning? New Student
Returning Student

Preferred Day

Preferred Time

Length of Lesson 30 minutes
45 minutes
60 minutes

Frequency Weekly
Bi-Weekly

Instrument or Class

Teacher

New or Returning? New Student
Returning Student

Preferred Day

Preferred Time

Length of Lesson 30 minutes
45 minutes
60 minutes

Frequency Weekly
Bi-Weekly

General Information & Policies

Please read the Kamloops Symphony Music School's General Information & Policies for all students and parents/guardians here.

Please read the Kamloops Symphony Music School's Student & Parent/Guardian Code of Conduct Policy here.

Please read the Kamloops Symphony Music School's Student & Parent/Guardian Health & Hygiene Policy here.

* To be completed by the Student: (or by Parent/Guardian if the student is under the age of 18): I acknowledge and agree to be responsible for my safety (and the safety of my child) while on the premises of the Kamloops Symphony Music School. Further, I accept responsibility for damage caused to the facility by my actions (and those of my child) and agree to indemnify the Kamloops Symphony Music School for any damages arising as a result of those actions. Yes

* I have read and agree to adhere to the General Information & Policies above: Yes

* I have read and agree to adhere to the Student & Parent/Guardian Code of Conduct above: Yes

* I have read and agree to adhere to the Student & Parent/Guardian Health & Hygiene Policy above: Yes

* I agree to receiving monthly informational newsletters pertinent to the KSMS: Yes

* Your Name: