Westminster Conservatory
2017-2018 Registration Form


Fill out one Registration form per student.

NOTE: Items marked * are required.






Student Information
 * Last Name of Student:
 * First Name of Student:
 * Home Address 1:
Home Address 2:
 * City:
 * State:
Province/Region: (If State is "Other")
 * Zip/Postal Code:
 * Country:
 * Home Phone of student 
(w/ area code):
()
Cell Phone of student 
(w/ area code):
()
Student Email Address:
Are there any special circumstances of which you would like us to be aware? Please explain:
 * Student is a: Returning Student    New Student   
If a new student, where did you hear about us?
 * Student is: Male    Female   
 * Student is: Adult   Under 21  
 * Student is Senior Citizen 
(over 60):
Yes     No    
If Student is an adult:  If student is an adult, the following
 is required to be filled out!
Employer/Position :
Work number of student 
(w/ area code):
()
 
If Student is under 21:  If student is under 21, the following
 is required to be filled out!
* Birth Date (month/day/year):
* Grade as of Sept. 2017:
* Name of School:
 
 
Please fill out the information below so that we may schedule the lessons and   
the teacher will be able to contact you in case of lesson cancellation.
Father/Guardian Name:
Employer/Position of father/guardian:
Father/Guardian Work Phone (w/ area code): ()
Father/Guardian Cell Phone (w/ area code): ()
Father/Guardian Email Address:
Mother/Guardian Name:
Employer/Position of mother/guardian:
Mother/Guardian Work Phone (w/ area code): ()
Mother/Guardian Cell Phone (w/ area code): ()
Mother/Guardian Email Address:
 
Private Lesson Request
 
Instrument Requested:
Number of Years of Study:
Teacher request, if any:
Lesson Length requested: 30    45    60   
 
Location requested: Princeton       Princeton Academy
Lawrenceville South Brunswick
Yardley         
 
Enter all the times that you
are available for lessons:
  Monday :      
    Tuesday :     
    Wednesday : 
    Thursday :    
    Friday :        
    Saturday :    
 
Which day and time is 
your first choice:
 
Other requests, if any:
 
 
Second Instrument requested,
if any :
Number of Years of Study:
Teacher request, if any:
Lesson Length requested: 30    45    60   
 
Location requested: Princeton       Princeton Academy
Lawrenceville South Brunswick
Yardley        
 
Enter all the times that you
are available for lessons:
  Monday :      
    Tuesday :     
    Wednesday : 
    Thursday :    
    Friday :        
    Saturday :    
 
Which day and time is 
your first choice:
 
Other requests, if any:
 
 
Class or Group requests:
Class requested (See class
schedule on the web site) :
 
Class Day :
Class Time :
Location requested: Princeton       Princeton Academy
Lawrenceville South Brunswick
Yardley        
Other requests, if any:
 
 
Second Class requested, if any
(See class schedule on the web site) :
 
Class Day :
Class Time :
Location requested: Princeton       Princeton Academy
Lawrenceville South Brunswick
Yardley        
Other requests, if any:
 
Billing Information
 * Send Bill To: Mr.    Mrs.    Ms.    Dr.   
 * Name:
 * Email Address:
 * Is Billing Address the same as student home address listed above? Yes     No     (If "No", please specify below.)
Billing Address 1:
Billing Address 2:
City:
State:
Province/Region: (If State is Other)
Zip/Postal Code:
 * Country:
 
Payment Information
* Please read the conditions of registration and check the box indicating that you accept them. NOTE: Refunds, credits, or make-ups cannot be given for lessons missed by the student.
  I understand and accept the conditions for registration / withdrawal as outlined above and in the Westminster Conservatory 2017-18 catalogue. 
  I Accept
 
  A non-refundable family registration fee of $40 plus the appropriate tuition deposit must accompany this form.
  Private Lessons
  $150 per student per instrument for 30 minute lesson
  $200 per student per instrument for 45 minute lesson
  $250 per student per instrument for 60 minute lesson
  Classes and Ensembles
  $100 per mini-session for Rhymes and Rhythms
  $150 per mini-session for Musical Playground and Musical Threes
  $  75 per student per class or ensemble for all other classes and ensembles
  Honors Music Program
  $500 per student for Young Artist or Young Musician
  $150 per student for Young Music Scholar
  Full payment may also be made (see catalogue for correct amount)
 
 * Payment Amount
(Tuition deposit listed
above plus $40
registration fee) :
$
Daytime Phone
(w/area code):
  ()
 * Payment Information:  We accept Visa, MasterCard, Discover & American Express.
Card Type :
Credit Card Number:
Expiration Date (MMYYYY):
Security Code :
Name as it appears on card:
 * Is Credit Card Billing Address the same as Billing Address listed above? Yes     No     (If "No", please specify below.)
Billing Address 1:
Billing Address 2:
City:
State:
Province/Region: (If State is Other)
Zip/Postal Code:
Country:
 
Form Submission


Click Submit to send this form to Rider University. An acknowledgement screen will then appear.