Spring Valley Piano Lab Registration 2021-22
In-School Piano Labs begin September 27.
We will schedule After School Piano when we have the staffing resources. Watch your email for schedule confirmation before sending your student to After School Piano.

PLEASE COMPLETE AND RETURN REGISTRATION FORM AND $15 FEE TO YOUR SCHOOL OFFICE BY FRIDAY, SEPTEMBER 24, 2021. ADD $5 TO FEE IF YOU CHOOSE AFTER-SCHOOL PIANO, FOR A TOTAL OF $20.
(Cash, check or money order payable to The Gilmore, in an envelope, with the student's name on the front.)

Payment plans are available. Call Adam Schumaker or Leslie Baron at The Gilmore, 269-342-1166.

Registration and payment can also be mailed to:
THE GILMORE, ATTN: PIANO LAB, 359 S. KALAMAZOO MALL, SUITE 101, KALAMAZOO, MI 49007-4843

Once you submit this form, you will have the option of paying online.
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Is your student new to Piano Lab or returning? *
Student First Name *
Student Last Name *
Preferred Name
Pronouns
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Write in pronouns if needed
Student Age *
Birth Date (MM/DD/YY)
Classroom Teacher
Grade in School *
Student's KPS student email address for use in Google Classroom
Student owns or has access to a piano/keyboard on a regular basis?
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If yes, what kind of piano?
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PARENT/GUARDIAN INFORMATION
Parent/Guardian First Name *
Parent/Guardian Last Name *
E-mail address *
May we text your cell phone number? *
Street Address *
City *
State *
Zip Code *
Home Phone (land line)
Work Phone
Cell Phone *
Emergency Contact First Name *
Emergency Contact Last Name *
Email Address *
May we text your cell phone number? *
Street Address *
City / State
Zip Code
Home Phone
Work Phone
Cell Phone
After School Piano Program Information
After-School Piano (ASP) meets once a week after school.  Students who participate get an extra Piano Lab practice session supervised by a Piano Lab instructor, plus the chance to do other fun music-related activities. Practice sessions are divided by grade and run from 3:45 to 5:00 PM. Participating students will have the option of eating a free after-school meal, provided by Communities in Schools.

Bus transportation is not provided. Parents must pick up students by 5:30 PM.  

Students are expected to attend their assigned day each week that the program is in session.  
Grades 4-5 meet on Monday / Grades 3-4 meet on Tuesday / Grades 2-3 meet on Wednesday

STUDENT ASSIGNMENT CONFIRMATION  WILL BE SENT HOME BEFORE THE PROGRAM BEGINS.  
PLEASE DO NOT SEND YOUR STUDENT TO ASP IF YOU HAVE NOT RECEIVED CONFIRMATION.
After-School Piano Registration *
Keys2Kids Keyboard Lending Program Information
The Keys2Kids Keyboard Lending program is for students participating in Piano Labs who do not
have an instrument at home for practice. The Gilmore can lend one (1) keyboard per family, free
of charge, while students are participating in the program. Families who choose to participate will
receive a keyboard and full details after registration, while supplies last.
Keys2Kids Keyboard Lending
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In consideration for being allowed to participate in the Gilmore Keyboard Festival’s programs, I agree to assume the risk of such activities and programs; and I further agree to hold harmless The Gilmore and its staff members conducting the activities from any and all claims, suits, losses, or related causes of action for damages including out-of-school trips by van or bus, understanding that competent leadership is provided. The Gilmore is not responsible for lost, stolen, or damaged personal articles. I also authorize The Gilmore to have and use music composed by my child, photographs, and audio and/or video recordings of me, my child, or family as may be needed for public relations programs. I acknowledge that this General Release of Liability is binding on me, my representatives, and program participants.
PARENT/GUARDIAN SIGNATURE *
DATE *
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