Conservatory of Music Registration


Name:   Sex:   Date of Birth:
    Male Female    
  (please use MM/DD/YY format)
Address:
Home Phone:   Work Phone:   Email:
       
School:   Grade:
   
Other Family Members Enrolled In Conservatory:

Do you attend church?   If yes, where?
Yes No    

If student is living with parents or guardian, please complete:

Parents' Names:
Business Phone:   Cell Phone:
Father:   Mother:   Father:   Mother:
           
Desired private instruction:
Piano Trumpet Bass Guitar Voice French Horn
Acoustic Guitar Flute Saxophone Drums/Percussion Oboe
Trombone Violin Clarinet Tuba/Euphonium

Length of lessons desired (violin minimum 45 minutes):
30 minutes 45 minutes 60 minutes

Day of week preferred (Monday through Friday):
First choice:     Second choice:
Time of day preferred (be specific):

How many previous years of instruction have you had?

Requested instructor (returning students only):