Registration

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2004-2005 Music School Registration Form

(NOTE: An asterisk (*) - denotes a required field)

If you are enrolling more than one student or require lessons for more than one instrument, please click on the "Submit & Enroll" button below to continue registration. You will be redirected back to the registration page after initial tuition package is processed. Please note: a separate registration form is required per student, per instrument.

Session Information:

Check all that apply*:

Spring Summer Fall

New Student Re-registration

Student Information:

Last Name*

First Name*

Gender*:

Male Female

School*

Grade*

Date Of Birth (MM/DD/YY)*

Address Line 1*
Address Line 2

City, State, Zip*

Telephone (Primary)*

Telephone (Secondary)

E-mail Address

Parent / Guardian Information:

Last Name*

First Name*

Relationship*

Work Phone

Company

Occupation

Second Parent / Guardian Information:

Last Name

First Name

Relationship

Work Phone

Company

Occupation

General Information:

Instrument*

Skill Level:*:

None Basic Intermediate Advanced

N.Y.S.S.M.A. level (Optional - NY residents only):

N/A 1 2 3 4 5 6

Does student currently Own or Rent a working instrument?*:

Own Rent None

How did you hear about The Amadeus Conservatory of Music?*

Other:

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