Elementary Band & Strings Program Registration Form - 2012/2013

LEARNING SERVICES
Ph: 604-903-3777 Fax: 604-903-3778

NO REFUNDS WILL BE MADE AFTER SEPTEMBER 28, 2012

School: Student Information: Last Name: Address: City: Parent/Guardian Information: Parent/Guardian Name: Home Phone: Email: Select program(s) Band Program (Gr. 5-7) Strings Program - offered at some schools (Gr 4-7) Select Level Beginning in the program Continuing in the program from prior year Work Phone: Postal Code: First Name: Date of Birth (dd-mm-yy): Grade (Grade level in 2012/2013):

REFUND POLICY: There is a $75.00 non-refundable processing fee for all students. Once the program starts, all resources are committed for the year. Please obtain the refund form from your school office.

(Braemar, Canyon Heights, Cleveland, Dorothy Lynas, Highlands, Larson, Montroyal, Ross Road and Seymour Heights)
EARLY BIRD - TWO FEE PAYMENT OPTIONS Please check the appropriate box:

OPTION 1: Single Payment of $415.00

OPTION 2: Three Payments - $425 total - First Payment of $205 by May 4, 2012 - Second payment of $110 by June 8, 2012 - Third Payment of $110 by July 13, 2012 Payable by post dated cheques or credit card Expiry: Expiry: Signature for Credit Card Authorization: July cheque No:

****** After July 13, 2012 registration fee will be $460

Credit Card: Visa Card #: Master Card #: Name of Cardholder (please print): Cheque: Record your: May cheque No: June cheque No:

Cheques made payable to: NORTH VANCOUVER SCHOOL DISTRICT * ** *** **** A $25.00 charge will apply for all NSF cheques received. Please print the surname of the student on cheque (if different) from the pre-printed name appearing on the cheque. Your registration fee does not include instrument rental and method book. Your registration includes approximately 60 hours of instruction and performance opportunities Date:

Parent / Guardian Signature:

09-Mar-2012

Print Form

2150-99-02

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