early childhood music online application please fill out form below Early Childhood Music Online Application Form Child's Name * First Name Last Name Gender Preferred Pronouns Date of Birth * MM DD YYYY Parent/Caregiver's First and Last Name * Caregiver's Preferred Pronouns Cell Phone Number Country (###) ### #### Email * Preferred Method of Communication Email Text WhatsApp Who will be attending Family Class with them each week? Same as above Someone else School / School Town / Grade Year * If applicable Child's Allergies Is there any information the teacher should know? For example: Is there anything that the ECM Instructor should be aware of prior pertaining to the child's learning abilities? 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 Early Childhood Music class. I have read and understand the Early Childhood Music 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 2025-2026 Media Release Agreement Between Palaver Strings and Participating Early Childhood Music 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 Thank you!
