CSA Early Childhood Fall 2020 Registration & Contract

CSA Early Childhood Registration & Contract

Please complete one form per student
Student Name - Proper name, no nickname*

First NameLast Name
Student Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Age*

YearsMonths
Gender*

FemaleMale
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Mother's Name (enter N/A if not applicable) - Proper name, no nickname*

First NameLast Name
Mother's Email*
example@example.com
Mother's Cell Phone *

Area CodePhone Number
Father's Name (enter N/A if not applicable) - Proper name, no nickname*

First NameLast Name
Father's Email*
example@example.com
Father's Cell Phone*

Area CodePhone Number
Primary Contact Person*

MotherFatherOther
Primary Contact Person (other than Mother or Father)

First NameLast Name
Primary Contact Cell Phone (other than Mother or Father)

Area CodePhone Number
Primary Contact Email (other than Mother or Father)
example@example.com
In an emergency, CSA should call:*

MotherFatherOther
Medical Treatment Agreement*

I authorize CSA to seek emergency medical treatment for this student, if necessary.
How did you hear about CSA?*

Friend recommendationWebsite or web searchSocial MediaMy child has attended CSA classesOther
Program of Interest*

Early Childhood Music - Babies (birth-18 mo)Early Childhood Music - Toddlers (18 mo-3 yrs)Early Childhood Music - Preschool (3-4 yrs)Early Childhood Music - Pre-Kindergarten (from age 4)Early Childhood Music - Kindergarten (from age 5)Early Childhood Music - Keyboard Level 1 (from age 6)Early Childhood Music - Keyboard Level 2 (required completion of Keyboard level 1)Early Childhood Music - Keyboard Level 3 (required completion of Keyboard level 2)Early Childhood Music - Young Musicians 4 (required completion of Keyboard level 3) - Monday, 3:50-4:50pm, Cardwell (21210)Early Childhood Music - Young Musicians 5 (required completion of Keyboard level 4) - Monday, 6:00-7:00pm, Cardwell (21229)
Early Childhood Class Day/Time Preference - Babies
Select class day and time using the drop down arrow
Toddlers Class - 1st Choice
Select class day and time using the drop down arrow
Toddlers Class - 2nd Choice
Select class day and time using the drop down arrow
Preschoolers Class - 1st Choice
Select class day and time using the drop down arrow
Preschoolers Class - 2nd Choice
Select class day and time using the drop down arrow
Pre-Kindergarten Class - 1st Choice
Select class day and time using the drop down arrow
Pre-Kindergarten Class - 2nd Choice
Select class day and time using the drop down arrow
Kindergarten Class - 1st Choice
Select class day and time using the drop down arrow
Kindergarten Class - 2nd Choice
Select class day and time using the drop down arrow
Keyboard Level 1 Class - 1st Choice
Select class day and time using the drop down arrow
Keyboard Level 1 Class - 2nd Choice*
Select class day and time using the drop down arrow
Keyboard Level 2 Class - 1st Choice
Select class day and time using the drop down arrow
Keyboard Level 2 Class - 2nd Choice
Select class day and time using the drop down arrow
Keyboard Level 3 Class - 1st Choice
Select class day and time using the drop down arrow
Keyboard Level 3 Class - 2nd Choice
Select class day and time using the drop down arrow
Babies Class Materials*

Babies: Complete Material Set, $45 (21261) (strongly recommended)No materials needed
Toddlers Class Materials*

Toddlers: Complete Material Set, $43 (21162) (strongly recommended)No materials Needed
Preschoolers Class Materials*

Preschoolers: Complete Material Set, $48 (21119) (strongly recommended)No materials needed. Student has Cycles Wind Dancer or Sun Catcher book&CD
Pre-Kindergarten Music Makers 1 Class Materials*

Music Makers 1 Complete Material Set (folder, parent book & CDs), $53 (21120)Music Makers 1 Sibling Set (folder only, I have parent book & CDs), $34 (21145)
Kindergarten Music Makers 2 Class Materials*

Music Makers 2 Complete Material Set (folder, parent book and CDs), $60 (21147)Music Makers 2 Sibling Set (folder only, I have parent book & CDs), $34 (21146)
Keyboard Level 1 Class Materials*

Keyboard Level 1 Complete Material Set (book & CDs), $60 (21121)Keyboard Level 1 Sibling Material Set (book only, I have parent book & CDs), $26 (21122)
Keyboard Level 2 Class Materials*

Keyboard Level 2 Complete Material Set (book & CDs), $52 (21123)Keyboard Level 2 Sibling Material Set (book only, I have CDs), $26 (21124)
Keyboard Level 3 Class Materials*

Keyboard Level 3 Complete Material Set (book & CDs), $52 (21125)Keyboard Level 3 Sibling Material Set (book only, I have CDs), $26 (21126)
I would like to begin instruction*

Fall semesterSpring SemesterAs soon as possible
Discounts (check all that apply)

Wheaton College EmployeeSibling DiscountOther
If you selected Wheaton College Employee above, please fill in the employee name Employee Name*, Wheaton College department College Department* , Employee title Employee Title* , Wheaton College ID Card Type (Faculty/Staff) ID Card Type* , Wheaton Employee email address Email* and relationship to student Relationship* . This information will be verified by the Human Resources department. Thank you. .
CSA Policies

Changes in enrollment
Withdrawal

The withdrawal process begins with spoken communication with the teacher. Once this is completed the parent should send a Withdrawal Request email to the Director (csa@wheaton.edu). This email should confirm they have spoken to the teacher and have the approval to withdraw.

A $35 cancellation fee will be assessed for students who enroll and subsequently withdraw prior to the first class. A student who withdraws during the first four weeks of the semester will be charged for the weeks prior to withdrawal, plus 50% of the semester’s remaining tuition. For a withdrawal after week four of the semester there is no tuition refund except in the case of serious illness or relocation, the final determination of which shall be made by CSA.

Tuition and payments
Tuition is billed by semester and payable in full by 12/10 (Fall semester), 4/10 (Spring semester), and 8/10 (Summer semester). Statements are sent monthly to the email on file. Monthly payments are acceptable. A $50 fee will be assessed for any returned checks.

Past Due Accounts
Delinquent accounts will be charged a 7% fee following the Final Due date each semester/summer . CSA reserves the right to suspend or discontinue instruction of any student with a past due account.

Attendance/make-up
Students are expected to be present for all lessons and classes.

Tuition assistance
Thanks to the generous support of our Annual Campaign contributors, limited tuition assistance is available for students with demonstrated need. Aid is awarded based on documented tax returns, family size, and is subject to availability of funds as well as facility and program capacity.

Applications are reviewed twice a year and strict deadlines are as follows:
- July 1—Fall semester
- November 1—Spring Semester
Health policy
Providing a healthy environment for all participants in CSA is a priority to the organization. Therefore, CSA and Wheaton College reserve the right to limit attendance at lessons/classes to teachers and students, determined at our discretion, not to be a health risk to others. Participants suffering from infectious diseases, open wounds, persistent coughs or colds or other potentially transmissible health conditions are to cancel lessons. The effect on tuition of such changes will be in accordance with the Attendance/Make-up Policy.

Student photographs
Photographs and video footage of students engaged in class, lessons, or performance activities may be used for publicity purposes.

Weather cancellations
CSA does not necessarily follow public school cancellations. When weather conditions are questionable, cancellation notification will be as follows: Classes—check CSA website at csa.wheaton.edu. Private Lessons—teachers will notify students.

Equal opportunity
CSA does not discriminate on the basis of race, color, age, nationality, sex, ethnic origin, or religious belief in its admission, financial aid or other educational policies.

E-mail
We communicate many important details via e-mail. Please add csa@wheaton.edu to your contacts.
Policies*

I have read and agree to all the CSA policies and procedures found at csa.wheaton.edu. Subject to these conditions, I agree to pay for all charges and services rendered.
Withdrawal Policy*

I acknowledge and agree to the following Withdrawal Policy: The withdrawal process begins with spoken communication with the teacher. Once this is completed the parent should send a Withdrawal Request email to the Director (csa@wheaton.edu). This email should confirm they have spoken to the teacher and have the approval to withdraw. A $35 cancellation fee will be assessed for students who enroll and subsequently withdraw prior to the first class. A student who withdraws during the first four weeks of the semester will be charged for the weeks prior to withdrawal, plus 50% of the semester’s remaining tuition. For withdrawal after week four of the semester there is no tuition refund except in the case of serious illness or relocation, the final determination of which shall be made by CSA.
New Registration Fee*

I agree to submit the required $35 non-refundable registration fee to the CSA office within one week. Class or lesson placement will not begin until this fee has been received.

Payment Method *

Click Here to pay $36.35 online (includes $35 Registration Fee and $1.35 Online Processing Fee). Enter "New" for CSA Student ID field.

Mail a check of $35 to Wheaton College CSA, 501 College Avenue, Wheaton, IL 60187

Questions about Registration?
If you have any questions, please enter them here and the office will contact you.
Signature*

Clear
Please type signature name here*
Date*

MonthDayYear
Date
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CSA Early Childhood Registration & Contract