Summer Flute Academy Registration | Pakachoag Music School

Please complete the form below.

When finished, you can click “submit” and make payment with credit card or paypal. Or you can choose to mail in a check within two days.
Watch for a confirmation email when payment is processed.

2023 Summer Flute Academy

Please complete and submit this form as part of the registration process.

"*" indicates required fields

Step 1 of 3

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Student Information

Student Name*

First Last

Student Date of Birth*

For adult students, you are welcome to enter 01/01/1920 if you prefer not to be specific about age.

MM slash DD slash YYYY

How long have you or your child played the flute?*

Less than a year

1 year

2 years

3 years

More than 3 years

Do you/your child take or have you taken private lessons?*

Yes - Currently

Yes - in the past

Do you take or have you taken any group lessons?*

Yes - Currently

Yes - in the past

Have you / your child played in any ensembles? currently or previously.*

School Band

Orchestra

Other ensmble

If school-aged, what is the name of your school? Or please note if home-schooled.

Are you enrolling for...*

Group 1 - 7 Weeks ($190)

Group 1 - 6 Weeks ($175)

Group 2 - 7 Weeks ($295)

Group 2 - 6 weeks ($280)

If missing a week (or more), which week...

June 29, 2023

July 11, 2023

July 13, 2023

July 18, 2023

July 20, 2023

July 25, 2023

July 27, 2023

Spotlight Opportunities

Would you/your child wish to be considered for a teaching spotlight? This benefits both the class and the individual. Spotlight Students will be asked to prepare one short piece (about a half page for Group 1; full page for Group 2) to play for the spotlight portion of a class.

Yes Please!

Maybe

No thank you

Misc. Information

Any disability that precludes using stairs?*

Does the accompanying adult, other attending family member(s), or scheduled student have any physical disability that might preclude using stairs? If this is an issue, we will do our best to problem solve around class space.

Yes

How did you find us / hear about us?*

Multiple choices are fine.

Word of Mouth: Friend/Family Referral

Word of Mouth: School Teacher Referral

Online: Social Media (Facebook, Instagram, Etc.)

Online: Search Engine (Google, Bing, Etc.)

Print Media: Newspaper, Concert Program, Etc.

Print Media: Brochure, Postcard, Etc.

Attended a Pakachoag Performance or Event

Other

STUDENT Ethnicity for Grant Reporting*

We appreciate your reporting on this item which helps us report back to grantors around student reach and service. Information is used in aggregate only.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

Two or More Races

White

Prefer not to respond

Other

Contact Information

Parent/Guardian 1 or Adult Student Name*

First Last

Parent/Guardian 1 or Adult Student Email*

Parent/Guardian 1 or Adult Student Phone*

Texting / SMS

Do you wish to receive texts on this number?

YES, the School may send texts to this number.

NO, I do not want to receive texts on this number.

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian 2

First Last

Parent/Guardian 2 Phone

Texting / SMS

YES, the School may send texts to this number.

NO, I do not want to receive texts on this number.

Parent/Guardian 2 Email

Payment Information

Payment Method*

How would you like to pay?

I will pay by credit card or PayPal upon form completion

I will mail in check within next 2 days. Total due will be displayed on final page of form.

I have applied for Financial Aid. (We will email you an invoice with revised deposit amount.)

I am faculty and need a separate invoice.

Support a Student In Need Option

Would you like to make a donation to the Music Matters program for children/youth of low income? Thank you.

Yes, please add a $10 donation to my final payment.

Yes, I'd like to contribute to the average cost of a class, a $20 gift.

Yes, I'd like to pay for an upcoming lesson, a $40 gift.

Not at this time

Additional Information Request

Please let us know if you would like additional information regarding...

Financial Aid

Payment Plan Options

Other

Consents

Photo/Video Consent*

Do you give Pakachoag Music School permission for yourself and/or your child(ren) to be photographed and/or videotaped during school functions for school purposes and for such photos or videos to be used commercially by the school, including postings on social media or the School web site. We do not use names (unless approved by special request) when posting.

Yes

Other

Please review our Summer Program Policies at this link prior to completing registration, and confirm your acceptance below. Scroll down that page to find the "Summer Policies" section. Summer Registration & Policies

Summer Policies Consent & Waiver of Liability COVID-19*

This includes policies related to absences, visiting the school, and safety/health as noted on the Summer Registration Web Page.

Waiver of Liability COVID-19: https://pakmusic.org/release-of-liability-covid-19/.

I have read, understand, and agree to the School's summer policies and COVID-19 Health Policies. I have read, understand, and consent to the School's Release of Liability COVID-19 waiver. I understand classes may need to be moved online if circumstances require.

Section Break

Total

If paying by check, please make check payable to PakMusic and mail within 2 days of submitting this form. If paying by credit card, click the PayPal button and you will be able to use any credit debit card to make payment - NO PAYPAL ACCOUNT REQUIRED

You may use any credit or debit card to make payment. Click until you see the gray button to pay without a PayPal account.

Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Comments

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