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Musica Franklin Registration 2019-2020-- Sheffield
Please note: this form is for the confidential administrative records of Musica Franklin and will not be shared with or distributed to any other entity for any purpose. Completion of this form is required for participation in Musica Franklin programs.
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* Indicates required question
Student Name
*
Your answer
Grade Level
*
Your answer
Age
*
Your answer
Gender
*
Male
Female
Non-Binary
Musical Experience, if any
Your answer
Parent/Caregiver 1 Name
*
Your answer
Parent/Caregiver Address
*
Your answer
Parent/Caregiver 1 Home Phone
*
Your answer
Parent/Caregiver1 Work Phone
Your answer
Parent/Caregiver 1 Cell Phone
Your answer
Parent/Caregiver 1 Email
*
Your answer
Parent/Caregiver1 Preferred Contact Method
*
Choose
Home Phone
Work Phone
Cell Phone
Text
Email
Parent/Caregiver2 Name
Your answer
Parent/Caregiver2 Address
*
Your answer
Parent/Caregiver 2 Home Phone
Your answer
Parent/Caregiver 2 Work Phone
Your answer
Parent/Caregiver 2 Cell Phone
Your answer
Parent/Caregiver 2 Email
Your answer
Parent/Caregiver 2 Preferred Contact Method
Choose
Home Phone
Work Phone
Cell Phone
text is preferred
Email
Emergency Contact--Full Name & Phone Sc
*
Your answer
Photo and Video Release: By checking below, I give permission for my child to appear in photos and videos taken by Musica Franklin, or a person authorized by Musica Franklin. We will never identify students by their full name.
*
LOCAL publication, including newspapers, community television, Musica Franklin promotional materials
INTERNET distribution, including e-newsletters, social media, web site, etc.
I DO NOT give permission for my child to appear in any public photos or videos
Required
I have read and agree with the following Program Requirements:
*
I understand that Musica Franklin meets Monday through Thursday 3:30-5:30, plus a 30-minute weekly lesson to be scheduled on Fridays between 3:30 and 5:30. Students are expected to come every week. Musica Franklin is not a drop-in program.
Anytime my child is absent from school, I will call or text 617-610-2601 and tell the program.
Attendance at all concerts, rehearsals and family nights are mandatory for my child and I will do my best to ensure his/her success by committing to this requirement.
I understand that family nights are a time to celebrate the students’ achievements and support their work, and it is important for me to be there.
I give permission for my child to participate in Musica Franklin.
Required
CONFIDENTIAL: We apologize for asking for the following six questions with sensitive information. It is important for our records and for the funding Musica Franklin receives. The answers you provide are completely confidential and will never be used except as anonymous, aggregated statistics. Your responses are optional. Your cooperation in providing this information is very much appreciated.
Your answer
Student Ethnicity
Hispanic/Latino/Latina
Black/African American
American Indian or Native Alaskan
Native Hawaiian or Pacific Islander
Asian
White
Prefer to Not Say
Primary Language Spoken at Home
Your answer
Household Size: # Adults
Your answer
Household Size: # Children/Dependents
Your answer
Annual Household Income
Under $16,000
$16,001-$21,000
$21,000-$26,000
$26,001-$31,000
$31,001-$36,000
$36,001-$41,000
$41,001-$46,000
$46,001-$51,000
Over $51,000
Prefer to Not Say
Is your child diagnosed with a physical, mental or learning disability or have an IEP at school?
Yes
No
Prefer to Not Say
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