introduction to strings online application please fill out form below Introduction to Strings Online Application Form Student Name * First Name Last Name Gender * Male Female Prefer to not disclose Date of Birth * MM DD YYYY Age * Primary Language Spoken at Home Race / Ethnicity Check all that apply Asian Indigenous American or Native Alaskan Black or African American Native Hawaiian or Other Pacific Islander White Latino Other Other Race / Ethnicity: Parent(s) or Guardian(s) Names * Primary / Home Phone * Country (###) ### #### Cell / Work Phone Country (###) ### #### Email * School / School Town / Grade Year * If applicable Town Email * choose instrument and class time * Violin: Mondays 5:45pm - 6:30pm Violin: Wednesdays 6:00pm - 6:30pm Viola: Wednesdays 5:45pm - 6:30pm Cello: Wednesdays 2:45pm - 3:30pm Mission Statement The Palaver Music Center strives to generate a mutual love of music, foster creativity, and hold space for shared dialogue with people from diverse cultural and socioeconomic backgrounds. Tuition Tuition is based on a sliding scale model meaning that the program cost is dependent on yearly house-hold income and family-size. Please check the sliding scale to determine how much the program costs. Financial Aid Palaver is committed to ensuring that any student wishing to participate in the program can. If you feel the sliding scale fee is not affordable you may apply for financial aid. Applications can be found on our website at www.palaverstrings.org/intro-to-strings. You may also email Matthew Smith at matthew@palaverstrings.org for an application. Parent's Statement of Commitment * Please check and sign I would like my child to apply to the Introduction to Strings class. I have read and understand the Introduction to Strings description. I also understand that if accepted I will keep Palaver updated with any changes in the above information. * Signed Date of Application Form * MM DD YYYY 2022-2023 Media Release Agreement Between Palaver Strings and Participating After-School Strings Students and Families Student Name First Name Last Name Photographs, Recordings, Video and Film Images Introduction to Strings student performances and/or classes may be photographed, filmed, videotaped, and/or recorded. Palaver Strings has the students and families’ permission to use all images and sound recordings for publicity and to describe and illustrate the program to the public, print & online media, and funding organizations. I understand and agree with the policy outlined in the above paragraph. * Yes, I understand and agree with the policy outlined in the above paragraph. No, I prefer to opt out of the media release. If you selected "No" above... ...please tell us why in a few short words. * Signed Date of Release Form * MM DD YYYY Line Thank you!
