Santa Barbara Conservatory of Music Foundation
Registration Form

Student Information

Student Name: *

Date of Birth: *

Age:

Grade:

School (if applicable):

Gender (optional):

Parent/Guardian Information

Parent/Guardian Name:

Relationship to Student:

Address:

Phone (Home):

Phone (Cell): *

Email: *

Emergency Contact

Name: *

Relationship: *

Phone:

Lesson Information

Instrument / Program:PianoViolinGuitarVoiceFluteEar Training/TheoryEnsembleOther

Preferred Teacher (if any):

Lesson Type:Private LessonsGroup ClassEnsemble / Chamber Music

Preferred Days/Times:

Previous Musical Experience

How long has the student studied music?

Previous teacher or school (if any):

Does the student read music?

Goals or areas of interest:

Tuition & Payment

Tuition Amount:

USD

Payment Method:Credit CardBank Transfer

Payment Plan:Full QuarterMonthly

Photo & Video Release

I grant permission for photo/video use.I do not grant permission.

Signature: *

Date

Policies Agreement

I have read and agree to the school policies.