MMEA Future Music Educators Summit
Both the Parent/Guardian and the participating student must sign below by November 14th to acknowledge acceptance of the Event Regulations. A copy of this form submission will be sent to the Parent/Guardian email address and the Music Teacher/Ensemble Director email address. This is so that music educators are able to keep track of who has submitted their registration forms by the deadline. This opportunity is open to Massachusetts high school students in grades 9-12 interested in music education. The event features collegiate and music educator panels, breakout workshops, and time for conversations with college representatives.
Student Name
*
First Name
Last Name
School Name
*
School District Name
*
Grade (This opportunity is open to students in grades 9-12 in the 25-26 school year).
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Date of Birth
*
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Month
-
Day
Year
Date
Teacher/Ensemble Director Name
*
First Name
Last Name
Music Teacher/Ensemble Director Email Address
*
example@example.com
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Home Phone Number
*
Cell Phone Number
*
Business Phone Number (Optional)
In an emergency, notify
*
Relationship
*
Emergency Home Phone Number
*
Does the student take medication?
*
Please Select
Yes
No
If yes, what medication?
If yes, what dosage?
If allergies, please specify
If illness, please specify
Does the student have any dietary restrictions?
*
Yes
No
If the student does have dietary restrictions, please specify here.
Event REGULATIONS
Chaperones are expected to be present for the entire duration of the event.
Students will provide their own lunch and snacks. Please be mindful of nut allergies.
Students are not allowed to leave the Worcester Area Mission Society without their designated chaperone.
Students are unable to drive themselves to this event and must be accompanied by an adult chaperone.
Students will be required to wear their MMEA issued name badges at all times during the event.
Students participating in the MMEA Future Music Educators Summit are not permitted to purchase, possess, consume, or be under the influence of alcohol, illegal drugs or illegal substances at any time. Violators will be subject to stringent disciplinary action and sent home at their family’s expense.
Smoking is not permitted at any time or in any location during this event.
Student Commitment Contract
I have read the policies governing my participation in the MMEA Future Music Educators Summit. I agree to the policies and guidelines set forth in the above-mentioned document.
Student Signature
Date of Student Signature
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Month
-
Day
Year
Date
Student Email Address
*
example@example.com
PARENT/GUARDIAN PERMISSION
I, (parent/guardian name of the above named child), submit the above emergency medical information and give my permission for my child to participate in this event under the conditions described above. I hereby acknowledge that my child may be photographed or recorded and shared on social media and MMEA publications. I agree, for myself and on behalf of my child, that I will hold MMEA and its officers and employees harmless on account of any injuries or property damage that my child may incur as a result of participation in the event, except to the extent caused by the gross negligence or willful misconduct of MMEA or its officers or employees.
Parent/Guardian Signature
*
Date of Parent/Guardian Signature
*
-
Month
-
Day
Year
Date
Submit
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