Armonia Cuscatleca: Registration 
Eligibility Requirements:

  1. Student ages 7-12 
  2. Income verification 
Student does not need to have prior musical experience in order to participate in the program. 

If you need help with the pre-registration form please email us at armoniacuscatleca@gmail.com or call us at (818) 694-3024. 


Email *
STUDENT INFORMATION
First Name *
Last Name *
Date of Birth
 *
HH
/
BB
/
TTTT
Gender
 *
Student Email
Home Phone
 *
Student Cell Phone
SCHOOL INFORMATION
What school does your student currently attend? *
Write out the full name of the school.
Current Grade Level
 *
RACE/ETHNICITY DESCRIPTIONS

Please select the race or ethnicity that best describes you

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.


Black or African American: A person having origins in any of the black racial groups in Africa. 


Latine: A person of Latin American origin or descent

 
Middle Eastern: A person having origins in any of the original peoples of the Middle East. 


Indigenous/Native: A person having origins in any of the original peoples of North/Central/South America and who maintains a tribal affiliation or a community bond.


Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.  

White: A person having origins in any of the original peoples of Europe or North Africa.Untitled Title
 *
SIBLINGS
 *
Does the student have one or more siblings enrolled in Armonia Cuscatleca? 

HOUSEHOLD INFORMATION
Street
 *
City
 *
State
 *
Zip *
GUARDIAN INFORMATION
Contact 1

Parent/Guardian Name
 *
Phone Number
 *
Class reminders and updates will be sent to this number.
Email *
This is the email we will use to send follow up information regarding this application.
Contact 2

Parent/Guardian Name
Phone Number 
Email
EMERGENCY CONTACT
This individual will only be contacted if the above contacts are unreachable
Emergency Contact Name
Emergency Contact Phone Number 
Language Most Spoken at Home *
PRIOR MUSICAL EXPERIENCE
Does your student know how to read music?
 *
Does your student have any experience playing music?
 *
HEALTH INFORMATION
Is there any health information you would like your child's teacher(s) to be aware of? *
This could be ADHD, seizures, allergies, asthma, anxiety/depression, etc.
Wajib diisi
Describe any health information you would like your student's teacher to be aware of.
(If not proceed to the next question)
What is the student's covid-19 vaccination status?
 *
Wajib diisi
TECHNOLOGY ACCESS
Please select the devices your student has reliable access to
How did you Hear about Armonia Cuscatleca?
 *
I heard about Armonia Cuscatleca from this source
Do you declare that the information provided in this application is true?
 *
Parent/Guardian Signature

 *
(Please write your full name as electronic signature)
Signature date  *
HH
/
BB
/
TTTT
Kirim
Kosongkan formulir
Jangan pernah mengirimkan sandi melalui Google Formulir.
Konten ini tidak dibuat atau didukung oleh Google. Laporkan Penyalahgunaan - Persyaratan Layanan - Kebijakan Privasi
Google Formulir