2nd Baptist Church
Thursday, February 23, 2012

Registration

 
Thanks for registering.  We look forward to working with you!
 
Name (first and last):      Male Female     Date of Birth (mm/dd/yy):
 
Your Address     Street:      City:      State:      Zip:
 
Home Phone:      Work Phone:     Email:
 
School:     Grade:
 
Other family members enrolled in Conservatory (including this student if more than one instrument):
 
Do you attend church? Yes No      If yes, where? 
 
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           Drums/Percussion   Oboe      Saxophone
Trombone             Violin          Clarinet                     Tuba/Euphonium
 
Length of lessons desired (violin minimum 45 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):