Private Lessons Placement Form For New Students

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Returning Conservatory Students:

You do not need to fill out this form, confirm your lesson details with your teacher and go directly to registration.

New Conservatory Students:

Please use the form below to request placement with an instructor.

* denotes required field

Student Information

Student First Name*
Student Last Name*
Age* Gender

Student or Parent/Guardian Information

Student is under 18 Student is older than 18
If the student is under 18, please enter the parent/guardian information in this section.
First Name*
Last Name*
Relationship to student*
Telephone (daytime)*
Telephone (other)
Email Address*
Confirm Email Address*

Musical Experience

Choose one only.

I am a beginner student (no previous lessons to Royal Conservatory Grade 2)
I am an intermediate student (Royal Conservatory Grade 3-6)
I am an advanced student (Royal Conservatory Grade 7-10+)

Musical Goals

Choose one only.

I am looking for information.
I want to take exams and earn certificates.
I want to perform.
I don't have a specific goal in mind.

Musical Interests

Choose all that apply.

  • Classical
  • Concert band (wind instruments)
  • Fiddle
  • Jazz
  • Musical  Theatre
  • Pop
  • Rock
*Is there a specific teacher that you would like to work with?
If you chose 'Yes', please indicate the name of the teacher

Additional Information

Please provide any information you feel is pertinent to being placed with an instructor.

Preferred Date and Time

(indicate all that apply)

  • Morning - 9am-12pm
  • Afternoon - 12-5pm
  • Evening - 5-9:45pm
  • Morning
  • Afternoon
  • Evening
  • Morning
  • Afternoon
  • Evening
  • Morning
  • Afternoon
  • Evening
  • Morning
  • Afternoon
  • Evening
  • Morning
  • Afternoon
  • Evening
  • Morning
  • Afternoon
  • Afternoon
When would you like to start your private lessons?  
How did you hear about the Conservatory?

The University of Regina collects information under the authority of The University of Regina Act and in accordance with the Local Authority Freedom of Information and Protection of Privacy Act and the Personal Information Protection and Electronic Documents Act for purposes of the administration of the University and its programs and services. By responding to this form, you are consenting to the University of Regina using your personal information to receive information related to your inquiry and submission of this form, as well as other Centre for Continuing Education programs and services.