STUDENT  INFORMATION  SHEET

TODAY’S DATE: ____________________


CLASS OPTION:  Private Piano:  MS [   ]     DA[   ]   Basic[   ]                    Group Piano[  ]
Guitar [   ]             Violin[   ]                Viola [   ] 
To view the details of
<==== any Class Option, click on
the name of that option

STUDENT’S NAME: _______________________________________   BIRTHDATE:   ______________

PHONE NUMBERS: HOME: _______________  CELL:______________   ALTERNATE: ______________

NAME OF SCHOOL: ______________________________________   GRADE IN SCHOOL: _________

PRESENT MUSIC TEACHER’S NAME (if from this area): ______________________________________

[For Piano Students] I HAVE A:       PIANO  [  ]          KEYBOARD (full size):  [  ]           none:  [  ]

OTHER ACTIVITIES, HOBBIES, INTERESTS:  ______________________________________________

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    clef                     note                    clef                    note                    clef                    note

PARENTS’ NAMES:_______________________________________________________

ADDRESS:  ______________________________________________  CITY/ZIP:  ____________________

E-MAIL ADDRESS:  __________________________________________

WORK PHONE:  ____________________________   CELL PHONE:  _____________________________

WHY IS MUSIC INSTRUCTION FOR YOUR CHILD/YOU IMPORTANT TO YOU?:  _____________________

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Please tell us how you learned about Coppell Conservatory.    Thank you.
From friends 
Saw the school 
Door Hanger
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Other



ENOLLMENT  AGREEMENT

I have read The Coppell Conservatory information on:

REGISTRATION
TUITION
LATE FEE
SCHEDULE
MISSED LESSONS
INSTRUMENTS and METRONOMES
WITHDRAWAL
PARENT VISITATION and CONFERENCES
WAITING ROOM, DROP/OFF, PICK/UP
CALENDAR

I agree to the stated policies of The Coppell Conservatory.  I understand that failure to adhere to the  stated policies may result in suspension or termination of enrollment.

__________________________________________           _______________________________________
Parent Name (please print)                                               Student Name (please print)

_________________________________________            _______________________________________
Parent/Adult Student Signature                                          Date


 
AUTHORIZATION  FOR  PICK-UP

The following individuals (other than parents) are allowed to pick up my child/children from The Coppell  Conservatory.  These persons may be asked for identification.


1.      __________________________________________

2.     __________________________________________
   
 
 

__________________________________              _________________________
Parent Signature                                                             Date

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