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Student Information Form

Please fill out and submit the following information and preferences regarding your music lessons:

All fields marked with an (*) are required

    -- If Student is Under 18 --


















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    Terms & Conditions

    (applicable to students, and/or parents/guardians if students are not yet 18)


    To sign up for at least 16 weeks of lessons.To provide at least 4 weeks prior notice of termination of lessons by email to daniel@revolutionmusicint.com.That if the student needs to pause lessons for any reason before the first 16 weeks is up, I need to provide at least 2 weeks prior notice of the pause, and also the date the student will be returning, and that the student may only have a maximum pause of 8 weeks, or else I will be charged for the remainder of the lessons plus any late fees acquired.To purchase from Revolution Music International any instructional materials required for the lesson content.To pay for monthly lessons on or before the 1st day of the month. Otherwise, the balance will have a 10% late fee per month.To provide at least 24 hours notice of cancellation of a scheduled lesson, and I will have one month to do a make-up lesson.To pay a yearly $20 administration fee that will be charged upon signing up, and every September thereafter.To not hold Revolution Music International, its locations, or any of the staff or teachers liable.

    Revolution Music
    8415 D 169 st NW Edmonton, AB T5R 2W7
    Monday - Friday: 8 AM - 5 PM
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