Community Music School
 
WIU Community Music School, String Orchestra Program Registration

Student Information
Student's Full Name:
Instrument Play:
Years Played:
Age:
Grade:
School:
Home Address:
Primary or Home Phone No.:
Secondary or Student Cell Phone No.:
E-Mail Address:
(student email if applicable)
Parent Contact Information
Parent Name (First, Last)
Mom Contact Info:
Primary Contact Phone Number:
Cell Phone Number:
Email:
Dad Contact Info:
Primary Contact Phone Number:
Cell Phone Number:
Email:
Emergency Contact Info
Name:
Cell Phone Number:
Relation:
Parent Instruction and Confirmation

Yes No

Choose here if you give permission for pictures or name of student to be used for
publicity in publication such as, but not limited to, newsletters, newspapers
and magazines, and WIU brochures.

Parent signature for permission to enroll:

Instruction:

Type in your First Initial and Last Name

Date:


Registration Information

  • $75 per semester (Scholarships available if financial need)
  • $150 per year (Scholarships available if financial need)

Checks payable to: Community Music School at WIU

Payment due on or before 1st rehearsal for participation

Please mail (or bring to first rehearsal) completed form and check to:

Dr. Richard Cangro
School of Music
Western Illinois University
1 University Circle, Macomb, IL 61455

   

 

 

 

 

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