Clone of Provo Harmony Hub Registration

1
Thank you for your interest in Mundi Project's Harmony Hub Piano Classes! Please review the following details to familiarize yourself with the Harmony Hub program:

Age Groups:

Youth classes include learners from age 8 to 18.

Family class students range from age 6-100; children must be registered with an adult relative.

No unregistered children are permitted in any class.

Location:

Kearns Library - 4275 W. 5345 S. Kearns, UT 84118

Schedule:

Classes begin Saturday January 17. The last event is a Showcase that will be April 18.

10:30 am Beginning Youth
11:30 am Beginning Family
12:30 pm Intermediate Youth
1:30 pm Intermediate Family

Language: All classes will be held in English, though we encourage everyone to join regardless of their proficiency in the English language.

Accessibility Information: Mundi Project is committed to ensuring our music experiences are accessible to all. If you would like to request accommodations, please email Zach Jacob - zjacob@mundiproject.org with any questions regarding disability accommodations.
2
Student's Name* This field is required.This is who will be attending the class.
First Name
Last Name
3
Student's Age* This field is required.Minimum age without a registered Parent/Guardian is 8 years old. Minimum age with accompanying registered Parent/Guardian is 6 years old.
4
Parent/Guardian Name
First Name
Last Name
5
Email* This field is required.
example@example.com
6
Phone Number* This field is required.
Please enter a valid phone number.
7
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Are you registering for a youth class or a family class?* This field is required.Youth classes are for youth registering without a parent in the class. Minimum age 8. Family classes are for children with accompanying parents in the class. Minimum child's age 6.
Please Select
Please Select
Youth Class
Family Class
9
Family Class timesBe sure to complete registration forms for each student, including parent(s). Minimum student age is 6 years old. No children under 6 years old are permitted in the class. No unregistered children are permitted in the class.
10
Youth Class timesMinimum student age is 8 years old. No children under 8 years old are permitted in the class. No unregistered children are permitted in the class.
11
While everyone is welcome to register for Harmony Hub classes, Mundi Project primarily serves individuals whose circumstances have limited their access to music education. Please select all of the following descriptors that apply to your circumstances (all information provided will be kept anonymous):* This field is required.
Low income
Single Parent Household
Disability
Immigrant/Refugee
Homeless
Unemployed/Underemployed
High medical expenses
None of the Above
12
Student Information

You will now be asked to provide additional demographic information about each learner. The demographical information (Race/Ethnicity, LGBTQ+ Status, and Language Preference) is used exclusively for statistical reporting to national and regional foundations that support Mundi Project as well as internal program evaluation. While the entry requires a response, you may select "Prefer not to answer" if you prefer not to report this information.

NOTE: If you need to register more than one student, please complete this form and fill out an additional form for the remaining student(s).
13
Student's Race* This field is required.
Please Select
Please Select
Asian
Black or African American
Hispanic, Latino, or Spanish origin
Multi-racial
Native American
Pacific Islander
White
Prefer not to answer
14
Student's LGBTQ+ Status* This field is required.
Please Select
Please Select
Yes
No
Prefer not to answer
15
Student's Gender* This field is required.
Please Select
Please Select
Male
Female
Other
Prefer Not to Answer
16
Media Release Agreement* This field is required.Please read and respond to the following Media Release Agreement: I give permission to Mundi Project to publish photos, videos, audio, and written testimonials obtained of programming participants and relevant family members, including Zoom recordings or other screenshots, on its website, social media, and any other publications or platforms. I release and discharge Mundi Project and its officers, employees, agents, and volunteers from and against any and all damages, complaints, costs, and fees arising from said use of such photos, videos, audio, and written testimonials. I agree to refrain from instituting, pressing, or in any way aiding any claim, demand, action or cause of action for damages, costs, compensation, or fees against the same in connection with such use. Agreeing to the Media Release Form does not imply that the aforementioned media will be published; it simply indicates that Mundi Project has permission to do so in the event it is needed. Disagreeing to the Media Release Form will not impact your participation in this course. We will blur out any individual in photos and videos who does not agree to the Media Release Form.
Yes
No
17
Please verify that you are human* This field is required.
Should be Empty: