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Private Summer Lessons Registration
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Student Information
First Name
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Last Name
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Birthdate
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Month
Day
Year
Gender
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X
Medical Condition / Allergies
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Yes
No
Please list
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Are you registering more than one child for music lessons?
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Yes
No
Please enter the names of the children
You will need to fill out a SEPARATE registration form for each child. A 10% discount will be applied to the total family tuition for 3 or more students registering together.
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Lesson Information
Instrument
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Piano
Guitar
Ukulele
Voice
Clarinet
Saxophone
Flute
Violin
Day of Lesson
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Wednesday
Thursday
Number of Lessons
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4
5
6
7
8
Tuition
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Contact Information
Name
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Email Address
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Primary Phone Number
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Alternate Phone Number
Contact Name of Alternate Phone Number
Street Address
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Unit Number
City
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Postal Code
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Finance Information
Are you a new customer to MSI Langley
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Bank Information
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Use same as on file
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Bank Account Holder's Name
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Institution Name
*
Account Type
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Chequing
Savings
Institution Number
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Branch Number
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Account Number
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Attach a PDF/JPEG of VOID Cheque
Accepted file types: pdf, jpg, jpeg, Max. file size: 5 MB.
Is the mailing address of the bank account holder different from the contact information you entered above?
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Name on Account
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Street Address
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Unit Number
City
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Postal Code
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Primary Phone Number
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Email
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Terms
Attendance
Missed private lessons are non-refundable.
If a student cancels a lesson, MSI Langley is under no obligation to provide refunds or make up lessons.
If a private lesson is cancelled or missed with less than 24 hours notice, the lesson is forfeited.
If more than 24 hours notice is given, a make up lesson is not guaranteed, however the instructor will put the student on their cancellation list. If the instructor is able to schedule a make up lesson, there is a maximum of 2 make up lessons for the summer term. Multiple attempts to reschedule a missed lesson are not guaranteed.
If a make up lesson is cancelled or missed by the student, the make up lesson is forfeited.
If the student wants to switch to an online lesson during their regularly scheduled lesson time due to sickness or Covid-19 Protocols, MSI Langley must be notified within 3 hours of the start of the lesson time so we can arrange with the instructor to switch the in person lesson to an online lesson via Zoom.
If the student comes to their lesson sick or with cold symptoms, they will not be taught and their lesson will be forfeited as there will be no time to switch to an online lesson.
Lessons missed by the instructor due to sickness or Covid-19 Protocols will either be taught online when possible or rescheduled.
Any pending make up lessons will be forfeited by August 31, 2025.
Attendance I agree
*
I agree
Lesson Payments
All Summer Lessons are paid for in advance. A $25.00 NSF Fee will be charged on ALL returned/failed payments. Please note that the bank requires ten business days to cancel preauthorized bank debit.
Authorization
I / We authorize Music Schools International Langley to withdraw from the financial information indicated (above) for the full payment of Summer Music Lessons on the day of registration or after the 1st of each month for the duration of the lessons. I/We also agree that all outstanding lesson payments may be withdrawn after withdrawal from lessons. I/We warrant and guarantee that the person(s) whose signature(s) are required to sign on the account have signed the authorization.
I may revoke my authorization at any time in writing or by phone, subject to providing notice of at least ten (10) business days. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, I may contact my financial institution or visit
www.cdnpay.ca
.
Reimbursement
I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with the PAD Agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit
www.cdnpay.ca
.
Lesson Payments, Reimbursement and Authorization I agree
*
I agree
E-Mail Communication Authorization
To receive important lesson, news and event information via email from MSI Langley, we are required by law to obtain your consent. If you agree, please check below.
Email Authorization I agree
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I agree
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