The Rivers School Conservatory Application Form
333 Winter Street, Weston, MA 02493 | (781) 235-6840 www.riversschoolconservatory.com
Date
-
Month
-
Day
Year
Date
Desired Start Date
*
Please Select
As soon as possible
Fall Semester (September - January)
Spring Semester (February - June)
Summer Semester (June - August)
Student Information
Student Name
*
Given First Name
Last Name
Preferred Name/Nickname
If different from Given First Name
Birth Date
*
/
Month
/
Day
Year
Age
*
Gender
*
Male
Female
Non-binary
Race
*
Please Select
Asian/Asian American
Black/African American
Middle Eastern
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
White/Caucasian/European
Other race not listed
Prefer not to say
Other Race not listed (optional)
Ethnicity
*
Please Select
Hispanic/Latinx
Not Hispanic/Latinx
Prefer not to say
Primary Instrument
*
Please Select
Bassoon
Cello
Clarinet
Drum Kit
Electric Bass
Electric Guitar
Flute
French Horn
Guitar (Acoustic/Classical)
Marimba
Oboe
Percussion
Piano
Saxophone (Alto)
Saxophone (Tenor)
Saxophone (Baritone)
String Bass
Trombone
Trumpet
Tuba
Viola
Violin
Voice
Select the instrument you want lessons for.
Years Studied
*
Preferred learning style (violin/cello only):
Traditional
Suzuki
Unsure
Current/Former Music Teachers
If applicable
Other Instruments
Only fill this out if you want RSC lessons for a SECOND instrument.
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
School
*
If adult student, please write "NONE"
Current Grade
*
Please Select
PK
K
1
2
3
4
5
6
7
8
9
10
11
12
Adult
Parent/Guardian 1 Information
If you are an adult student, please add your contact info here.
Parent/Guardian 1 Name
*
First Name
Last Name
Parent 1 Relationship
*
Please Select
Mother
Father
Parent
Step-Mother
Step-Father
Step-Parent
Guardian
Self (for adult students only)
Parent 1 Salutation
*
Mr.
Mrs.
Ms.
Dr.
Parent 1 Cell Phone
*
Parent 1 Home Phone
Parent 1 Email
*
example@example.com
Parent 1 Employer
*
Parent 1 Title
*
Parent 1 Business Phone
Parent/Guardian 2 Information
Parent/Guardian 2 Name
First Name
Last Name
Parent 2 Relationship
Please Select
Mother
Father
Parent
Step-Mother
Step-Father
Step-Parent
Guardian
Parent 2 Salutation
Mr.
Mrs.
Ms.
Dr.
Parent 2 Cell Phone
Parent 2 Home Phone
Parent 2 Email
example@example.com
Parent 2 Employer
Parent 2 Title
Parent 2 Business Phone
Submit Your Application
How Did You Hear About RSC?
*
Do you need to interview with RSC for private lesson placement?
*
I need to interview to be placed with a private lessons teacher.
I already know who is teaching me and when my lessons/rehearsals will be, and it has been discussed with the teacher.
Are you taking private lessons or ensembles?
Private lessons
Ensemble(s)
Both
Interview Date
/
Month
/
Day
Year
Date
Teacher Name
First Name
Last Name
First Anticipated Lesson or Trial Lesson
/
Month
/
Day
Year
Date
Day of Week
Please Select
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Lesson Time
Hour Minutes
AM
PM
AM/PM Option
Lesson Length
Please Select
30-minute lessons
45-minute lessons
60-minute lessons
75-minute lessons
90-minute lessons
120-minute lessons
Which Ensemble(s)/Class(es)
Submit
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