Summer 2023: June 26 to August 11 Student Information Student Name * First Name First Name Last Name Last Name Generational -- Jr.Sr.IIIIIIIVVVIVIIVIIIIXX Generational Preferred Pronouns Preferred Pronouns Birthdate * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Thank you for providing your birth date. We need accurate data for State and Foundation grant-writing and reporting purposes. Age Address * Address 1 * Address 2 City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code * E-mail * Primary Phone * Primary Phone Type * Cell Home Work Secondary Phone Secondary Phone Type Cell Home Work Workplace Job Title Health or learning issues we should be aware of Student Ethnicity Count * We celebrate our rich diversity and appreciate your help compiling accurate data for State and Foundation grant-writing and reporting purposes. White Black Hispanic Asian Other Prefer not to participate Emergency Contact Name First Name First Name Last Name Last Name Generational -- Jr.Sr.IIIIIIIVVVIVIIVIIIIXX Generational Preferred Pronouns Preferred Pronouns Relationship to student Address Country - None -United States Address 1 Address 2 City State - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code E-mail Primary Phone Primary Phone Type Cell Home Work Secondary Phone Secondary Phone Type Cell Home Work Private LessonsInstrument 1 Instrument Teacher Lesson Length - None -3/4 hour - $591 hour - $751/2 hour - $42 with Teacher Agreement – please call1 1/2 hour - $110 with Teacher Agreement – please call Instrument 2 Instrument Teacher Lesson Length - None -3/4 hour - $591 hour - $751/2 hour - $42 with Teacher Agreement – please call1 1/2 hour - $110 with Teacher Agreement – please call Day(s) and times of the week you are available Please provide the largest range of time possible. Example: Monday 5:00 to 9:00; Tuesday 2:00 to 7:00 Your Vacation Dates Please let us know if there are dates that you’ll be unavailable during the June 26 – August 11 session. Lesson Preference Most lessons are taught in-person but teachers are willing to teach remotely when requested. Please indicate your preference, if any, here. I prefer in-person lessons but will do remote lessons if necessary I prefer remote lessons but will do in-person lessons if my teacher advises I have no preference I will only do in-person lessons I will only do remote lessons Lesson Preference Notes Additional Comments Classes & Ensembles 1 2 3 Policies SUMMER 2023 TUITION, WITHDRAWAL & REFUND POLICIES: PRIVATE LESSONS: Students may enroll for a specific number of private lessons during our 7-week session based on their family’s and their teacher’s vacation schedules. In return for this flexibility, and in fairness to our faculty, there are no make-ups or refunds for student absences or cancelations once a schedule has been agreed upon; only teacher absences are made-up, refunded or credited in the summer. There are no refunds given if a student withdraws for any reason. RESCHEDULING PRIVATE LESSONS: We are willing to try to arrange an alternative lesson time in special circumstances. If you need to request rescheduling a lesson, please let us know as soon as possible. If rescheduling the lesson is not possible, the lesson is considered missed. No makeup or credit will be given. CLASSES AND ENSEMBLES: Tuition for ensembles and classes is based on an enrollment of at least 4 students, unless otherwise stated. Classes and ensembles may run with three students for an additional $69 (1 hour) per student. If only two students enroll, and the director and teacher feel they are a good match, each student will pay half the cost of a private lesson, with the parents’ agreement. We reserve the right to cancel any class or ensemble that is under enrolled; payment will be fully refunded. If a student withdraws from a class or an ensemble, no refund will be given. PAYMENT OPTIONS For continuing students: One payment – full payment for lessons and classes plus the $10 summer registration fee due by July 1. Two payments – half of your summer tuition plus the $10 registration fee due by July 1; balance due by August 1 For new students: One payment – full payment for lessons and classes plus the $10 summer registration fee due to complete the registration. Two payments – half of your summer tuition plus the $10 registration fee due at the time of registration; balance due by August 1 Financial Aid: Full and partial assistance is available based on need. Please fill out and submit the Financial Aid Application. Call Anne Houston at 508-856-9541 for more information. Photo Permission By submitting this registration form, you agree to photographs/videos being taken of you to be used in promotional or descriptive materials produced by or for the Joy of Music Program. If you do not give permission, please type “I do not give photo permission” in the box below. Policy Agreement * By typing my name above, I agree to abide by the policies of the Joy of Music Program. PARENT, GUARDIAN or Adult Student signature required (first & last names). Financial Aid I am applying for Financial Aid so my signature does not commit me to paying 100% of the costs.
