* Required

Junior PAI Registration

Student's Full Namerequired

Student's e-mail:required

Street Addressrequired

Cityrequired

Staterequired

Ziprequired

Genderrequired

Birthdaterequired

mm/dd/yyyy

Entering Graderequired

(in September this year)

Current Schoolrequired

Student's Music Teacherrequired

Mother's Full Namerequired

Home Phone #required

Work Phone #required

Cell Phone #required

Mother's Emailrequired

Mother's Address

(If different from student)

Father's Full Namerequired

Home Phone #required

Work Phone #required

Cell Phone #required

Father's Emailrequired

Father's Address

(If different from student)

Student's Instrument/Voicerequired

# Years of Experiencerequired

Does the student study privately?*

Yes No

If yes, Name and Address of Private Teacher

List the music student has performedrequired

Lesson Books and Music Used for Lessonsrequired

Please send info about PAI programs for students ages 12-18

Yes No

Wyoming Seminary requires all boarding and day students to be in compliance with Pennsylvania State Immunization requirements. We do not accept exemptions. Questions regarding immunization requirements should be directed to Beth Blaum R.N., B.S.N. Director of Student Health Services, at (570) 270-2180.

Wyoming Seminary maintains an open admission policy. Any student, regardless of race, color, religion, national or ethnic origin, may apply for admission to the school. This policy embodies Wyoming Seminary's commitment to enriching students' experience by living in a multicultural community.

Payment*

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Pay in full ($600) Pay registration fee only ($50)

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