Briarcrest Christian School, Memphis Tennessee - Fine Arts

Applied Lessons Registration Form

School Year:
Student Last Name:
Student First Name:
Gender:	Female Male
Age:
Homeroom:
Parents' Names:
Home Telephone:
Work Telephone:
Cell Phone:
Email Address:	(required)
Campus:
Number of Years of Prior Study:
Is the student a beginner?	Yes No

Lessons in:
Grade 1 and 2:
Grade 3 through 5:
Grade 6 through 12:

Conservatory teachers available:
Trisha Dorris - Piano Donna Glover - Piano Mary Simon - Piano Carole Tidwell - Piano Sandy Triplett - Piano Kay DeWitt - Voice Dr. Billy Rayburn - Voice Roxanne Murray Daws - Violin Josh Threlkeld - Guitar Jeff Haughton - Guitar Adam Clay - Percussion Jeremy Gill - Percussion
Teacher requested(if you have a preference):
First Choice:
Second Choice:
Third Choice:

Lesson times available:
Before School Recess P.E. Lunch Nap Time Silent Reading Time Study Hall Music (Middle/High School only) After School
Every effort is given to honor teacher and lesson time request. After teacher assignment is made, you will be contacted regarding your lesson day/time.
Lesson time requested:
First Choice:
Second Choice:
Third Choice:
Fourth Choice:
Fifth Choice:

I have read, understand, and agree to the policies set forth by the Briarcrest Conservatory of Fine Arts.

Briarcrest Christian School | 6000 Briarcrest Ave | Memphis, TN 38120 | (901) 765 - 4600