Application for Admission Form- 88

Please complete one form per student per instrument and include registration fee to begin the enrollment process.



Age______Gender ______ Date of Birth___________ School Grade_______

Instrument __________________________ Length of previous study on the instrument _______________

 Private Lessons, Lesson Length  30 minutes  45 minutes  60 minutes

 Group Lessons If Group, which class _______________________________


Home Address ___________________________________ City____________Zip Code___________

Home Phone_________________________Cell Phone_________________________ Okay to receive text messages

Mother’s Name _______________________________ Email ______________________________

Father’s Name ________________________________ Email ______________________________

How did you hear about our school? ________________________________________________________

*Have you read, understood, and agreed to our Yamaha School Policy?  Yes, Signature: _____________________


Preferred Day/Time for weekly lessons. Please provide both day and range of time available to start lessons.

1st Choice ______________________ 2nd Choice _______________________ 3rd Choice ___________________

What are your musical goals?_____________________________________________________________________

What types of music do you most enjoy?_____________________________________________________________

Is there any special learning or social conditions we should be aware of? ___________________________________


I authorize Yamaha Music School at Riverstone/ Fortissimo to initiate automatic monthly payments for tuitions.

 Monthly Payment installments: ACH automatic monthly charge, (circle one) checking account/ visa / master card

From: ___________________ to ____________________ (1st of each month)

If checking account is selected, please provide a voided check

Cardholder’s name ____________________Card #__ __ __ __-__ __ __ __-__ __ __ __-__ __ __ __Exp. Date ______

Signature______________________ Billing Address_________________________________________


Office Use Only

Reg. Fee ___1/ 2/ 3   __ Material Fee _Included_________ # of Weeks ___________1st and last  Mo. Tuition _________

Date of 1st lesson _________Time of Lesson__________

Advance payment discount:  Date info entered ________ Confirmation email:_______________ Staff initial __________


Reg. Fee: 1. $ 50 Per new student and re-registration fee (Student absence for more than 45 days)

                   2.  $ 40 Per additional Family Member

                   3.  $ 40 Per continuing student