Riverbend Conservatory of Music
Application for Enrollment: 2008-2009
The application below may be printed, filled out and brought by the church office or mailed to:
Brochures are also available in the church office.
Date__________
Student name____________________________________
Street address____________________________________
City________________________,FL. Zip_____________
Date of birth____ /____ /____ Home phone__________________
Business phone___________________ Cell___________________
E-mail address_______________________________________
Do you attend church?________
If yes, what church?__________________________________
If student is living with parents or guardian, please complete the following:
Parent's name(s)_____________________________________
Home phone_________________ Business_________________
Cell phone__________________
Please indicate from the list below which instrument(s) you are interested in studying.
I would like to study_________________________________
 | Piano |
| Voice |
| Guitar |
| Flute |
| Clarinet |
| Saxophone |
| Trumpet |
| French Horn |
| Trombone |
| Drums (percussion) |
Is there a specific teacher you would like to study with?
No_____ Yes_____ Name______________________________Financial Agreement
I, ___________________________________________ ,
am the financial party resposible for payment and have read and understand all information enclosed in the Riverbend Conservatory of Music brochure and agree to all policies. I agree to pay all fees set forth and understand the consequences involved in non-payment. I also understand that participation in any Conservatory program may be terminated at any time by giving written notice to the director, and that any unused fees may be reimbursed at that time.
Signed _________________________________________,
Date ____________