Application/Registration Form

Application date:
Enrollment date: Fall 2008 Spring 2008 Other*
* For Summer enrollment, please use form posted in Summer.

Student Information

First Name:		Last Name:
Birth Date:
School:		Grade:
InstrumentViolin      Viola      Cello
Orchestra  Teacher:		Private  Teacher:
Phone Number:
Street:		City:
State:		Zip:
Email:
Most recent pieces you have studied (if you have had no prior instruction, write "beginner")

Parent Information

First Name:		Last Name:
Home Phone:		Work Phone:
Street:		City:
State:		Zip:

Payment Information

Tuition (per 17-week semester):	$ Select One: Groups+30-min lessons=$665.00 Groups+45-min lessons=$885.00 Groups+60-min lessons=$1095.00 Groups+90-min lessons=$1280.00 New Beginner lessons =$590.00
Materials Fee (all students):	$10.00
Waiting List Deposit ($40.00):	$ Select One: 0.00 40.00 (non-refundable, will be applied toward tuition upon enrollment)
Total Amount:	$
*Material Fee is $15 for Beginners

Questions? Call Darcy Drexler at 414/963-4729

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