Fall Young Artists Academy Registration STUDENT INFORMATIONSTUDENT Name* First Last Student email (Optional)Only provide a student email address if the student wants to receive class updates Age as of Today*Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade (Fall 2022)*School (Fall 2022)*Will you be signing up for 1 or 2 ensembles?* 1 2 Instrument #1* Instrument #1: Number of Years Studied*Instrument #1: Private Instructor's Name* First Last Instrument #1: Private Instructor's Email* Would you like to add a second instrument?*Students will be put into two ensembles if the student wants to participate on two instruments, and fulfills the requirements, please select yes. Yes No Instrument #2 Instrument #2: Number of Years StudiedInstrument #2: Private Instructor's Name First Last Instrument #2: Private Instructor's Email Please select all the student identifies as. This data is only used for grant/funding purposes.* American Indian/Alaskan Native Arab Asian Black/African American Hispanic/Latino Native Hawaiian/Pacific Islander White Multi-Ethnic Other Physically, mentally, or otherwise impaired Prefer not to say PARENT/GUARDIAN INFORMATIONMain Parent/Guardian Name*This parent/guardian will be the Director of Education's main contact for the Academy. First Last Main Parent/Guardian Cell Phone*Main Parent/Guardian Email* Main Parent/Guardian Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Would you like to submit a second Parent/Guardian's information?* Yes No Secondary Parent/Guardian Name First Last Secondary Parent/Guardian Email Secondary Parent/Guardian Cell PhoneSecondary Parent/Guardian Address Same as main parent/guardian Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code ADDITIONAL INFORMATION ABOUT THE STUDENTIs this the student's first time playing in a chamber ensemble? What other chamber music experience has the student had? (outside of ACMC)*Describe the student's music reading abilities: are they quick to learn new music or does it take time to learn new music?*What repertoire (solos) and technical studies (etudes and scales) is the student currently working on? Please provide specific pieces and/or books.*The more we know about the student and their playing the better we can elevate their overall experience from putting ensembles together, to picking music, and to addressing individual differences and learning needs. Is there any additional information you'd like to share about the student enrolling? (optional)CONSENTParent(s)/Guardian(s) and Student grant permission to ACMC to use any photos and/or videos taken during the semester for non-commercial purposes.*Mainly we use photos/videos to share with our families, patrons, funders, and for grant reporting.Parent(s)/Guardian(s) and Student consentParent(s)/Guardian(s) and Student do not consentParent(s)/Guardian(s) and Student have read and agree to the In-Person Expectations and Protocols stated on the website.* All parties consentParent(s)/Guardian(s) and Student understand that if expectations and protocols are not met the student will be withdrawn from the program at the Director of Education's discretion without refund.* All parties consentHow did you hear about the Academy?*Please check all that apply ACMC Website ACMC Email ACMC Postcard Facebook/Instagram School Music Teacher Private Lesson Instructor TMTA PAYMENTOne Ensemble Tuition PriceTuition is non-refundable after August 17, 2022 for the fall semester$260 Full TuitionTwo Ensemble Tuition PriceTuition is non-refundable after August 17, 2022 for the fall semester. $500 Full Tuition$250 Deposit - balance of $250 due September 10Would you like to add a tax-deductible donation? Total $0.00 Credit Card*Card Details Cardholder Name CAPTCHA
