NA is acceptable for fields with no answer. New student OR returning student (check one) * New Student Returning Student Student First Name * Student Last Name * Instrument: Select all that apply. * Violin Viola Cello Guitar Home Address: Street address * City * Zip * Home Phone * xxx-xxx-xxxx Announcements and bulletins will be sent via email to the family email address and to the student’s email address if provided. One additional address may be included to receive these announcements. Family email address * Student’s email address Send announcements to this address also: The following section must be completed for group or chamber music assignment consideration for all students. If the student is a beginner (one who has not had any lessons), enter NA in required fields. If not a beginner but a first time registrant, please complete as much information as possible so we can assess the student’s correct placement. PreTwinklers-students not yet playing Twinkle in book 1—should put PT as their current piece. Please indicate NA if not applicable to registrant. Current Piece * Current Suzuki Book * List any supplementary books used at the previous lessons. * Scale book * Working in Theory Time Vol. # * Are you currently renting a UNI Suzuki School instrument? * Yes No If yes, indicate number * Only enter the number on the case, leave out letters. Parking tag orderTag will be available to pick up at registration Number of tags requested * x $31.80 (requires separate check payable to UNI) Student's birthdate * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015 Adult students can skip this section Grade in school School Mother/Father Mother OR Father Mother Father Name Mailing address if different from student’s Work phone xxx-xxx-xxxx Employer Email -if different from family email noted above Cell phone xxx-xxx-xxxx Mother/Father Mother OR Father Mother Father Name Mailing address if different from student’s Work phone xxx-xxx-xxxx Employer Email -if different from family email noted above Cell phone xxx-xxx-xxxx OTHER Title Email List individual lesson teacher for past spring semester * List individual lesson teacher for past summer * Select lesson length preference * 15 30 45 60 List all times student is available for lessons on each of the following days Monday * Tuesday * Wednesday * Thursday * Friday * Saturday * Please check any of the items below to receive audition information. * Northern Iowa Junior Orchestra (grades 5 – 8) $150 annually Northern Iowa Youth Orchestra (grades 9 – 12) $150 per semester Adult Orchestra $100 annually Verismo (chamber music) $80 - $150 per semester I am not interested UNI Suzuki School shirt Adult Small Adult Medium Adult Large Adult Extra Large Youth Small (4-6) Youth Medium (10 -12) Youth Large (14 - 16) New students receive their first one at no charge, current students will be billed for $7. Select one. Permissions Financial Obligation * I understand that my financial obligation to the UNI Suzuki School is for the entire academic year, late August through May. Should lessons be discontinued during that time, I agree to pay all fees in full. Early withdrawal with dismissal of fees may be granted upon DIRECTOR APPROVAL ONLY, in cases such as moving out of the area, injury or extended illness. I understand that if I default on payments, lessons will be discontinued and my bad debt will be sent on to a collection agency for payment. Other Fees * I understand that my financial obligation to the UNI Suzuki School will include a $125 per student registration fee and a $20 per student or $25 per family general activity fee (also known as the intent to register fee) and that these are both due before or at registration. Does not apply to adult students, adult orchestra members, and NIYO, NIJO or Verisimo only students. Participation * I understand that participation in all private lessons, group lessons, ensembles, recitals and concerts will ensure the optimum success and progress. Photo Release * I understand that the UNI Suzuki School may photograph and/or video record any UNI Suzuki School function which my family attend. I hereby grant UNI Suzuki School my permission to use such photos or videos for educational, historical or publicity purposes. Information Release * Your contact information will be shared with the UNI Suzuki Association and other staff members. I give the UNI Suzuki School permission to use my family email address listed above to share with other families on the website. * Yes No I give the UNI Suzuki School permission to share this email address with wcfsymphony * Yes No area music stores * Yes No Other concerns, questions or comments?