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Upbeat New Hampshire Semi-Private lessons Upbeat New Hampshire lecciones Semi-
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Email
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Your email
E-mail/
Correo Electronico:
*
Your answer
Student E-mail/Correo Electronico del estudiante
Your answer
Student Name/
Nombre del estudiante:
*
Your answer
Student Entering Grade/Grado al que el estudiante empieza
*
Your answer
Private teacher's name (if not taking lessons through Upbeat)/
Nombre del profesor privado (si no toma lecciones a través de Upbeat)
Your answer
Primary Contact/Nombre del Contacto Principal:
*
Your answer
Address/Direccion:
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Your answer
Phone Number (xxx) xxx-xxxx/Numero de telefono:
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Your answer
School/Escuela
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Amherst Street
Dr. Crisp
Bicentennial
Birch Hill
Mount Pleasant
Main Dunstable
New Searles
Home Schooled
Middle/High School
Other
Are you a returning student?/Eres un estudiante que regresa?
*
Returning student/Estudiante que regresa
New Student/Nuevo estudiante
Instrument/Instrumento:
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Violin
Viola
Cello/Violonchelo
Double Bass/Contrabajo
Would you like to have a high school student tutor practice with your 3rd to 5th grade student one day per week?
Le gustaria tener un tutor de escuela secundaria que practique con su estudiante de
3rd a 5th grado un dia a la semana?
Yes for a tutor/Si a un tutor
No for a tutor/No a un tutor
Clear selection
Lessons or performances may be photographed or videotaped. Do you give us to include your student in a photograph or video?
Lecciones o presentaciones pueden ser fotografiadas o filmadas. Usted nos da permiso
de incluir su estudiante en las fotohrafias o videos?
*
Yes/Si
No
If you are using an Upbeat instrument and there is damage beyond a simple repair you will take responsibility for the loss or damage.
*
I understand
I HEREBY AUTHORIZE ANY LICENSED PHYSICIAN, HOSPITAL, CLINIC OR OTHER MEDICAL FACILITY TO HOSPITALIZE AND SECURE PROPER TREATMENT FOR MY CHILD NAMED ABOVE (In an Emergency)
POR LA PRESENTE AUTORIZO A CUALQUIER MEDICO CON LICENCIA, HOSPITAL, CLINICA U OTRA INSTALACION MEDICA PARA HOSPITALIZAR Y
ASEGURAR UN TRATAMINETO ADECUADO PARA MI HIJO/A MENCIONADO/A ANTERIORMENTE (en caso de emergencia)*
*
Yes/Si
No
There are 15 lesson slots available per school. Selection is first come first served. Returning students are moved to the top of the list. I am aware that a payment form will be emailed to me within 2 weeks, if I applied within the first 15 applications. Tuition for the 2022-2023 school year will be $220. Scholarship rate will be $35.
Hay 15 espacios de lecciones disponibles por escuela. La seleccion es por orden de llegada. Los estudiantes que regresan son movidos al principio de la lista. Soy
conciente de que se me enviara un formulario de pago por correo electronico dentro de 2 semanas, si aplico dentro de las primeras 15 aplicaciones. La matricula para el ano escolar 2022-2023 sera $220. Y para estudiantes becados sera $35.*
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Yes/Si
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