Conservatory Application
Today’s Date______________ Student Birthdate ________________________
Student name______________________________________________________
Parents’ names_____________________________________________________
Address __________________________________________________________
City, State, Zip____________________________________________________
Home phone_______________________ Cell phone______________________
E-mail address_____________________________________________________
Please circle your choice of instrument to study:
Piano ... Trumpet ... Flute ... Voice ... Trombone ... Clarinet ... French horn ...
Guitar ... Saxophone ... Drums (percussion) ... Conducting
Do you have a preferred teacher? Yes No
If so, teacher’s name________________________________________________
Where do you attend church?_________________________________________
Eight lessons a) $22 per lesson – 30 minutes = $176
b) $31 per lesson – 45 minutes = $248
c) $39 per lesson – 60 minutes = $312
Family Plan (2 or more) – deduct $1 per lesson from tuition total for
additional, immediate family members taking lessons
Example (8 lessons @ 30 min): 1st student = $176 1) _________
2nd, 3rd, etc. = $168 2) _________
(8 lessons @ 45 min): 1st student = $248 1) _________
2nd, 3rd, etc. = $240 2) _________
(8 lessons @ 60 min): 1st student = $312 1) _________
2nd, 3rd, etc. = $304 2) _________
TOTAL: __________
Payment due before June 10, 2013
CHECKS PAYABLE TO: RCM (Riverbend Conservatory of Music)
NOTE: Payment required before enrollment is official.
OFFICE ONLY:
Received:_________ Cash Amt:________ Check Amt:________ Check # _______
