Sistema Huronia Music Academy Student Enrolment Form A

Form A(a): Student Application Process

Step 1: Complete Form A (b) - Student Application Form (Note a Parent/Guardian signature is required). An interview with the teacher, parent(s) and student may be scheduled prior to the acceptance to the program. Once we have reviewed the application, we will contact you to answer any questions that you may have. Upon being notified that your application has been successful, you will also be required to submit:

Form A(1): Student Medical information Form (Parent/Guardian Signature Required)
Form B: Media and Academic Records Release Form (Parent/Guardian Signature Required)
Form C: Student Code of Conduct Contract (Parent/Guardian and Student Signature Required)
Form D: Liability Release and Waiver Form (Parent/Guardian Signature Required)
Form E: Instrument Lending Agreement Form (Parent/Guardian Signature Required)
Form F: Child Pick-Up Form (Parent/Guardian Signature Required)
Form H: Sistema Huronia Parent/Guardian Contract (Parent/Guardian Signature Required)

For further information about the program or to see photos from previous years, please visit www.sistemahuronia.com.

The Sistema Huronia Music Academy (Sistema Huronia) program will, at its discretion, accept up to our maximum number of students from grades three to eight in any academic year. Applications will be reviewed by the Music Teacher and the Board of Directors Parent/Student/Teacher Liaison and will be approved on a first-come, first-served basis. When all places are filled, a Waiting List will be created. Applications from the Waiting List will be selected on a first-come, first-served basis as openings become available.

Depending on the number of children on the waiting list, applications will be held on file with the Board member responsible for Parent/Student/Teacher Liaison, and will be processed as time permits. These applications will be dealt with on a first-come first-served basis during the program year.

Any children actively participating in the program will be automatically considered for enrollment in the following year.

If you would like to attach additional information to the Application Form as to why you think your student would make an excellent candidate for the program, you are encouraged to do so.

Form A(b): Student Application

All information provided will be kept in strictest confidence by and only for the use of Sistema Huronia Music Academy and will not be used or shared by any unauthorized third party without specific and express written consent by an authorized parent or guardian.

Application Date:*

Date

Student’s Last Name:*

Student’s First Name(s):*

Student’s Date of Birth:*

Date

Student’s Current School:*

Student’s Current Grade in School:*

Student’s Current Teacher:

Student’s Prior Music Experience (No Experience Required): (Yes/No)*

If Yes, please describe:

What Instrument would your child like to learn how to play (Violin, Viola or Cello):*

Name of Parent/Guardian:*

Where did you find out about our program:*

Does your child participate in other activities?

Home Phone Number:

Work Phone Number:

Cell Phone Number:*

Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address:*

example@example.com

There will be opportunities to volunteer within the Sistema Huronia program. As this is a free program run by a volunteer Board of Directors and a paid music teacher, we encourage the student's families to give back to the program which can be accomplished in several different ways, some examples being: becoming a class volunteer at your student's class, by donating to the program (we are a Registered Charity that issues tax receipts) or helping out in other ways as they may arise throughout the term. Please indicate below if you, or any other family members 18 and over are willing or able to assist as a class volunteer:

Assist with daily in person music lessons: take attendance & other tasks as required. Typically this would be on the day(s) that your student(s) is(are) attending class. The frequency per month(s) would be determined by the number of other class volunteers signed up for that particular day. Please indicate your availability: Monday / Tuesday / Wednesday / Thursday:*

Please read and sign the "Terms and Conditions" section below:

I agree to ensure that my child attends the Sistema Huronia Music Program for the designated nights for 1.5 hours per day.

I understand that it is my responsibility to arrange for the safe arrival and timely pickup of my child.

I understand that the lessons and loan of instruments are free of charge as long as my child is registered in the program.

I agree to support practice at home by providing a structured time and place, and will assist my child by completing the practice form.

I agree to take responsibility for having an instrument at home, treating it with care and reimbursing Sistema Huronia for damage beyond normal wear of the instrument if necessary.

I agree to respond to emails within the deadline provided or within 24 hours if no specific deadline is provided, and to text or phone messages as quickly as possible in order for decisions to be made in a timely manner by those running the program.

Please note: There are no guarantees that your child will be eligible at this stage until final review of all applications. You will be notified in writing of the outcome of your application (see Registration Process).

Date:*

Date

Printed name of Parent/Guardian:*

Signature of Parent/Guardian:*

Sistema Hours: Monday (4:00-5:45), Tuesday-Thursday (4:15-6:00). Students will attend class 1 day/week which will be confirmed at the beginning of each term.