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Riverbend Conservatory of Music
Application for Enrollment (please print & complete)
Today’s Date______________ Student Birthdate __________________
Student name_______________________________________________
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 ... Guitar
French horn ... Saxophone ... Drums (percussion)
Do you have a preference on teacher? __Yes __No
If so, teacher’s name_________________________________________
Do you attend a church? __Yes __No
If yes, church name__________________________________________
If student is living with parents, please complete the following:
Parents’ names_____________________________________________
Address (if different from above)________________________________
City, State, Zip______________________________________________
Parents’ Phone (if different from above)___________________________
Financial Agreement
I, _____________________________________________ (print name of person responsible for payment),
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: _____________________________
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