First name participant: Last name participant: Date of birth:
First name parent/caregiver: Last name parent/caregiver: Street name plus house number: Zip code: Residence: Email: Phone:
Lesson type: Private lessons weeklyPrivate lessons biweeklyDuel lessons weeklyDuel lessons biweeklyChild/parent lesson
Location: YpenburgLoosduinenThe Hague Center
How did you find us: GoogleFacebookInstagramFacade AdvertisingMouth to mouth
Enrollment date:
Bank information for direct debit: Account Number (IBAN): Account holder name: Bank: Place bank: BIC:
By completing this form, I give permission to Hofstad Guitar Lessons to set up a direct debit for monthly dues for as long as the student is enrolled. This fee is divided into ten equal monthly installments that run from September through June. The monthly invoice will be sent on the first of the month, the direct debit will take place around the 3rd of the month.
I agree to the Terms and Conditions from Hofstad Guitar Lessons.