mail to:   The Salisbury School of Music, 213 S. Main Street, Salisbury, NC 28144


Registration Form

There is a one-time $25.00 registration fee per family.  
Please complete a separate form for each student.  

TodayŐs date:   ____/____/____ 

Student Name: __________________________________
  
Birth date: ____/_____/_____ 

If student is a minor, parentŐs name: ___________________________________ 

Address: _______________________________________________________   

Street :_______________________________________________________ 

City: _____________________________________  

State: _________ Zip __________ 

home phone: ____________________ work phone:_______________________   

cell phone: ______________________ e mail: _______________________________ 

You are requesting lessons in which of the following: (please circle) 

piano      voice      guitar       bass guitar	 brass      woodwind	violin

 Per-lesson fees. Fees are payable by the month at the first lesson each month. 
 
_____ Private, 30 min. ($20)   		 
____ Shared, 2 students, 30 min. ($15)* 
_____ Private, 45 min. ($27)   		 
____ Shared, 2 students, 45 min. ($18)* 

_____ Private, 60 min. ($36)   		 
____ Shared, 2 students, 60 min. ($26)* 
_____ Private, 20 min. ($15)   		 
____ Class,   3-5 students, 60 min. ($18)*              
(ages 7 & under only)  
*Students in shared lessons or classes need to be of similar level of ability.  
Shared lessons are only available when the similar students are available. 
If you are signing up with another person with whom you wish to share a lesson, please let us know.

www.salisburyschoolofmusic.com


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