Guyana Lutheran Music Academy
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2016-2017 Registration Form Please bring a copy of your Photo ID and a NON-‐‑REFUNDABLE $2,500 registration deposit (which counts towards September tuition). Students under 16 years of age need a parent/guardian signature. Please PRINT legibly.
Personal Information First Name: ______________________________________________ Last Name: _____________________________________________________ Age: _________ Male: ________ Female: ___________ Home Phone: ________________________ Cell Phone:______________________________ Work Phone:_____________________________ Email Address: ______________________________________________________ Home Address: ______________________________________________________________________________________________________________ List any other family or household members that are also enrolling in classes for the 2016-‐‑2017 school year: 1.___________________________ 2. ______________________________ 3. _____________________________ 4._______________________________ Current Occupation or School: _____________________________________________________________________________________________ Follower of any religion? Church name? __________________________________________________________________________________ Previous music instruction? Please circle: NO YES If yes, please explain (ex: 1 year of violin at GLMA):
____________________________________________________________________________________________________________________________________
Class Scheduling/Attendance Our program requires you to attend 2 weeknight classes (either Mon/Wed OR Tues/Thurs) and a weekend class on either Friday or Saturday. That means that you are learning music at least 3 hours a week, plus practice time! Our attendance policy allows for only 2 unexcused absences per quarter; after that you may be asked to leave classes. This is explained further in our Student Handbook. Please rank your course preference by writing a “1” next to your first choice, “2” by your second choice, and “3” by your third choice. Returning Students will be placed in Intermediate or Advanced classes if they are continuing on their instrument. New Students or Returning Students starting a new instrument will be placed in a beginning class. _____ Brass (trumpet, horn, trombone, or baritone) _____ Guitar _____ Keyboard _____ Percussion (snare, drum set, bells, etc.) _____ Violin _____ Choir _____ Woodwinds (flute, clarinet, alto saxophone)
There will be two sections of Beginning Guitar, Intermediate Guitar and Intermediate Keyboard. Students in these classes are asked to indicate their preferred time on the following page.
The table below shows our Monday-‐‑Thursday Schedule. Additionally, first year students will be expected to come to one general music class for an hour on Friday or Saturday afternoon. Second and third year students will have electives they may choose to take on Friday or Saturday. Students will sign up for these weekend class times in September. Please be sure that you sign up for a class that you will be able to attend! BEGINNING GUITAR, INTERMEDIATE KEYBOARD, AND INTERMEDIATE GUITAR STUDENTS PLEASE CIRCLE YOUR PREFFERED CLASS TIME, A OR B.
Mon./Wed.
Tues/Thurs. Beginning Keyboard
3:10-‐4:00 PM Beginning Percussion Intermediate Keyboard (A) 4:10-‐5:00 PM Intermediate Brass
Beginning Brass Intermediate Percussion
Intermediate Keyboard (B)
5:10-‐6:00 PM Intermediate Violin
Beginning Guitar (B) Intermediate Guitar (B)
6:10-‐7:00 PM Intermediate Guitar (A) Advanced Keyboard Beginning Guitar (A) 7:10-‐8:00 PM Beginning Woodwinds
Beginning Violin
Choir (7:10-‐8:20)
*This schedule is subject to change
Tuition and Scholarships Tuition i s $2,500 per month, and is paid during the f irst full week of every month. Total tuition for the year (9 months) is $22,500. The N ON-‐‑REFUNDABLE r egistration deposit of $2,500 is to ensure commitment to starting classes next September. If more than one person from your household is also enrolled in classes, there is a family discount of $500 for their tuition. Student 1 pays $2,500, and each other family member pays $2,000. Y ou will ONLY r eceive this discount if your f amily member names are listed on this f orm under the “Personal Information” section. If you are i nterested in applying for a needs-‐‑based scholarship, please fill out the scholarship application. Can you commit to the monthly tuition payments? Please circle: YES N O
Why do you want to learn music? ______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ How did you hear about GLMA? ______________________________________________________________________________________________________________________________________
Application Agreement I have read and understood this registration application. I have filled in the information to the best of my knowledge. I understand the requirements of tuition and attendance. Print name: __________________________________________________________ Date: ________________________________________________ Signature: ____________________________________________________________________________________________________________________ Signature of parent (if under 16): __________________________________________________________________________________________
