Rich Pond Fine Arts Academy
Student Registration

If you have multiple family members wanting to receive lessons, please fill out a different form for each student. Thank you.

Lessons are provided Monday and Tuesday evenings from 3:30-7:00
Student name
Your answer
Student's birthday
MM
/
DD
/
YYYY
Parent name (if different than the student)
Your answer
Phone number
Your answer
Email address
Your answer
Home address
Your answer
What instrument is this student wanting to receive lessons?
Has this student received lessons on this instrument before?
If you selected "Yes, from the Rich Pond Fine Arts Academy," how many semesters has this student received lessons from us?
What day would this student be available to receive weekly, 30 minute lessons?
Please list any other people that are allowed to bring/pick up your child for lessons.
Your answer
Please provide any other information or special circumstances that you may want us to know.
Your answer
PAYMENT SCHEDULE: Course fees are due in four installments of $80 each for Instructor and $62.50 each for Associate Instructor. Payments include fees for fourteen lessons and a $40 registration fee. The $40 registration fee will be waived beginning in the third semester of enrollment. The FIRST PAYMENT is due on or before the first lesson of the semester. Payments two through four will be due in three payments due the 15th of each month thereafter. Late payments will result in a $10 late fee. Please refer to our brochure for more information: http://www.richpond.org/fine-arts-academy/
Checks should be made payable to: Rich Pond Baptist Church and given to the door monitor or mailed to:

Rich Pond Baptist Church
attn RPFAA
200 Brad Ave.
Bowling Green, KY 42104

If you are completing this form online, please select SUBMIT at the bottom when finished. If you are completing a paper version, please mail this application to Adam Vincent, Director, Rich Pond Fine Arts Academy to the address above.
Thank you for your interest in the Rich Pond Fine Arts Academy!
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