AMLA Music Academy for Esperanza Students Registration Form

AMLA After School Music Academy

Program for students of Nueva Esperanza Academy
Artists & Musicians of Latin America (AMLA) promotes the development, dissemination, and understanding of Latin music and culture in the Philadelphia/Delaware Valley region with an emphasis on Youth.”

Our After School Music Academy is part of the After school programs at Nueva Esperanza Charter Schools.
Student Name

First NameLast Name
Student Information

This program is for students attending Nueva Esperanza Charter and Cyber schools.
Student ID Number
Student Email
example@example.com
Grade
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Select which class/es the student would like to join? You may select multiple.

PianoGuitar & BassViolinCelloPercussion & DrumsChoir
Please select one of the following dismissal instructions.

I give my child permission to walk home after being dismissed.My child is required to be picked up after school.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

Clear
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AMLA After School Music Academy