top of page

Student Registration Form

Thanks for taking the time to fill out this registration form ... we value your privacy, and no matter how much money any company or entity offers us, we won't sell your information - we like to take care of our students!!

It'll take you no more than 4 minutes to fill in this form, and may take you 6 or so minutes if you want to read the T&C's ...

Thanks!

New Student Registration - By putting your name below, and clicking "send" you are agreeing to our terms and conditions. To view the terms and conditions, please either click on the above link, or the tab to the side ... thanks!

Your Name (First and Surname)

Instrument

Your Level (beginner, Intermediate Advanced)

What Kind of Music do you (or the student) Like?

Your Birthday (we don't need the year, just day and month) ... If you are filling this form in for a child, please enter the child's Birthday! (we like to give birthday wishes to our students)!

Home Address

Home Phone Number

Mobile Phone Number

Email Address

Do you have any special needs or requirements, and if so, please let us know what we can do to help you:

By clicking send, you are agreeing to the terms and conditions of the Belfast Music Academy Ltd*

* Terms and Conditions

bottom of page