Issuu on Google+

Winter 2011 Program Registration

a non-profit community music school

Acct #______________ [R] [N]

Office of the Registrar 14360 SE Eastgate Way, Suite 102 Bellevue, WA 98007 P: 425.644.0988 | F: 425.644.0989 www.musicworksnw.org

Group Instruction Performance Ensembles

Other Parent/Guardian

Parent/Guardian Address

State

City Cell/Alternate Phone

Home Phone

Zip

Email Address

How did you learn about Music Works Northwest? Did you participate in a Music Works NW band/orchestra clinic at your school? If not, did you hear about Music Works NW from one of the following:

Yes

No

Music Works NW website

School Newspaper:

Twitter

Magazine:

Facebook

Referred by a Friend:

Band Director: Other website:

Student Information Instrument

Student Name

Date of Birth

Email Address Used for Facebook [Ex. registration@musicworksnw.org]

Twitter Username [Ex. @MusicWorksNW] Academic School Name

Gender

Grade

Academic School Music Teacher’s Name

Responsible Person Signature Required This form must be signed and dated by the person accepting the terms and conditions as stated below and on the back of this form. Registrations received without a signature will not be processed. Signature

Date

Print Name

Terms and Conditions Attendance: Regular attendance for all programs is expected. Students are charged for all activities for which they are registered, including those missed due to student absence. As a courtesy to the instructor or the group, please notify Music Works Northwest in advance of an absence prior to the session. Missed sessions or rehearsals due to student absence will not be made up and there will be no refund or tuition credit issued for student absences.

Tuition: Tuition must be paid in full prior to the first session, rehearsal or activity. After a student has registered for an activity, Music Works Northwest has committed space and time for that student regardless of student attendance. There are no refunds for student absences.

Group Instruction/Ensembles: Students enrolled in Group Instruction, Performance Ensembles, or other group activities are required to complete a registration form for each 7-week session. There will be no automatic registration or re-registration for group activities. In the event that the minimum enrollment for a group is not met, the student will be notified at least 48 hours in advance and a full refund will be issued.

Cancellation Policy: You may cancel your registration for a group lesson or performing ensemble for a full credit or refund up to two weeks prior to the first scheduled meeting of a group lesson or ensemble. Cancellations received between thirteen days to one day prior to the first scheduled meeting will receive a 50% credit or refund. No credit or refund will be issued for cancellations received on the day of or after the first meeting.

Office Use Only

Date Received: ____________

Tuition Due Upon Registration______________ Pmt Rec.________ Check #_________ Cash________ Card: V Invoice _______ E-mail _______ Tally Sheet ______ Constant Contact ______

MC

D


Student and Parent/Guardian Agreement and Permission 1. 2. 3. 4.

5.

I have read and agree to accept the terms and conditions outlined on the first page. I agree to pay tuition in a timely manner and financial penalties accrued by my child or myself due to non-payment, physical or property damage incurred on Music Works Northwest premises. I agree to make Music Works Northwest Registrar and student’s instructor aware of any medical conditions, medications or special medical concerns or needs of the student that affect the student’s performance and (or) attendance. I give permission to any Music Works Northwest representative to seek medical attention for my child or myself in the event of a medical emergency. I will be responsible for any and all medical and emergency transport expenses incurred. I grant permission to Music Works Northwest to use photographs, videos and recordings of my child or myself for promotional purposes.

Winter Programs: Check all appropriate boxes below. Group Lessons Keyboard Prep – Ages 6-9

Day Thu

Dates

Time

Price

Instructor

Item #

1/13 – 3/17

4:15p – 5:00p

$175

Olga Aronov

GIKP-Win11

10:00a – 12:00p

$48

Susan Strick

GISW-1S-2010/11

10:00a – 12:00p

$130

Susan Strick

GISW-3S-2010/11

10:00a – 12:00p

$250

Susan Strick

GISW-6S-2010/11

9/4,10/9,11/6,12/14, 1/8,2/12,3/12 TBD 9/4,10/9,11/6,12/14, 1/8,2/12,3/12 TBD 9/4,10/9,11/6,12/14, 1/8,2/12,3/12 TBD

Singers' Workshop : 1 Session

Sat

Singers' Workshop : 3 Sessions

Sat

Singers' Workshop : 6 Sessions

Sat

Adult Guitar

Sat

1/15 – 3/19

12:00p – 12:55p

$180

Barry Pollack

GIAG-Win11

Adult Vocal Performance Workshop

Sat

1/8 – 2/5

1:00p –3:00p

$190

Kristin Chambers

GIAVPW-Win11

Beginning Percussion – S1

Tue

1/11– 2/8

4:00p – 4:55p

$90

Scott Ketron

GIBP-S1-Win11

Beginning Percussion –S2

Tue

3/1-– 3/29

4:00p – 4:55p

$90

Scott Ketron

GIBP-S2-Win11

Continuing Percussion-S1

Thu

1/13– 2/10

4:00p – 4:55p

$90

Scott Ketron

GICP-S1-Win11

Continuing Percussion-S2

Thu

3/3– 3/31

4:00p – 4:55p

$90

Scott Ketron

GICP-S2-Win11

Pre-Teen Guitar for Beginners – S1

Fri

1/14– 3/18

4:30p – 5:25p

$180

Jim Ellis

GIPTG-S1-Win11

Pre-Teen Guitar for Beginners – S2

Sat

1/15 – 3/19

10:00a – 10:55a

$180

Jim Ellis

GIPTG-S2-Win11

Teen Guitar – S1

Fri

1/14 – 3/18

5:30p – 6:25p

$180

Jim Ellis

GITG-S1-Win11

Teen Guitar – S2

Sat

1/15 – 3/19

11:00a – 11:55a

$180

Jim Ellis

GITG-S2-Win11

Intro to Violin 1–Ages 4-6

Sat

1/15 – 3/19

9:00a – 9:55a

$180

Blayne Barnes

GIIV1-Win11

Intro to Violin 2–Ages 7-10

Sat

1/15 – 3/19

10:00a – 10:55a

$180

Blayne Barnes

GIIV2-Win11

Beginning Group Cello No class 2/23

Wed

1/12—3/23

7:00p – 7:55p

$180

Dr. Shiang-Yin Lee

GIBGC-Win11

Digital Multi-track recording

Thu

1/13 – 3/17

7:00p –8:55p

$360

Wiseman Studios

GIDR-Win11

Musikgarten: Cycles of Seasons for Preschoolers [Ages 3 to 5]

Tue

1/11 – 3/15

1:00p – 1:45p

$160

Dr. Shiang-Yin Lee

ECCOS1-Win11

Musikgarten: Cycles of Seasons for Preschoolers [Ages 3 to 5]

Thu

1/13 – 3/17

4:30p –5:15p

$160

Celine Ferland

ECCOS2-Win11

Musikgarten: Cycles of Seasons for Preschoolers [Ages 3 to 5]

Fri

1/14 – 3/18

4:30p –5:15p

$160

Celine Ferland

ECCOS3-Win11

Day

Dates

Time

Price

Instructor

Item #

Afro-Cuban Jazz Combo

Mon

1/10 – 3/14

7:30p – 8:50p

$210

Fred Hoadley

PEAC-Win11

Brazilian Jazz Combo

Wed

1/12 – 3/16

7:30p – 8:50p

$210

Eduardo Mendonca

PEBJ-Win11

Cello Choir

Wed

1/12 – 3/16

8:00p – 8:50p

$180

Shiang-Yin Lee

PECC-Win11

Fusion Combo

Wed

1/12 – 3/16

4:30p – 5:50p

$210

Dr. Ron Cole

PEFC-Win110

Jazz Combo

Wed

1/12 – 3/16

6:00p – 7:20p

$210

Dr. Ron Cole

PEJC-Win11

Vivace Flute Choir

Tue

1/11 – 3/15

7:00p – 8:20p

$210

Linda Bailey

PEVFC-Win11

Performance Ensembles


2010-2011 Winter Programs Registration Form