| STUDENT INFORMATION |
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| Student Name: * |
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| Gender: |
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| Date of Birth: * |
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Ethnicity:
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School Info: *
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| Student Contact Info: |
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| Student Can Accept Texts? |
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| Preferred Instrument: |
Guitar Bass Drums Keyboard Vocals
Back-Up Vocals Other |
Musical Information:
Please provide any info that will help us better understand student's musical background. |
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| Please list 1-3 examples of songs you would like to play: |
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CORE CLASSES
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Please make your class selections below.
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Select your class(es):
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AOR JUNIORS (Grades K-5) CLICK FOR CLASS DESCRIPTION
Mondays, 4-5pm @ Brownell (Grades K-2)
Tuesdays, 4-5pm @ Norwood Park (Grades 3-5)
Wednesdays, 4-5pm @ Brownell (Grades 3-5)
Wednesdays, 4:30 - 5:30 @ NFC* (Grades K-5)
*Dependent upon enrollment.
Saturdays, 10am - Noon @ NFC (Grades K-5)
AOR BEGINNERS (Grades 6-12) CLICK FOR CLASS DESCRIPTION
Mondays, 6-8pm @ NFC
Tuesdays, 6-8pm @ NFC
Saturdays, 12:15 - 2:15pm @ NFC
AOR GUITAR CLUB CLICK FOR CLASS DESCRIPTION
Guitar Club, Wednesdays, 3-4:15 @ Mickle
AOR @ BRYAN COMMUNITY CLICK FOR CLASS DESCRIPTION
Tuesdays, 2-4pm @ NFC
AOR ADVANCED/NEXT LEVEL (Grades 6-12) CLICK FOR CLASS DESCRIPTION
Saturdays, 2:30 - 4:30pm @ NFC
Wednesdays, 6-8pm @ NFC
Sundays, 12-2pm @ NFC
Thursdays, 6-8pm @ NFC
Sundays, 2:15 - 4:15pm @ NFC
AOR BLUES (By Permission Only) CLICK FOR CLASS DESCRIPTION
Advanced Blues, Sundays, Noon - 3pm @ Zoo Bar
AOR ADULT CLICK FOR CLASS DESCRIPTION
Sundays, 4:30-6:30pm @ NFC
LESSONS CLICK FOR DESCRIPTION
I am interested in taking individual lessons.
(You will be contacted with available lesson times.)
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ORIGINAL BANDS
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Please contact Bob@NFCLincoln.org for more information if you plan to enroll in the Original Bands Program.
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AOR ORIGINAL BANDS PROGRAM CLICK FOR DESCRIPTION
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To enroll an Original Band, EACH MEMBER of the band
must register in the Original Bands Program.
I wish to register an Original Band.
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| Original Band Name: |
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| Please list all band members & the instrument(s) they play: |
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| Original Band Parent Rep: |
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Original Band Class Time(s):
Wednesdays, 6-8pm @ NFC
Thursdays, 6-8pm @ NFC
Saturdays, 2:30 - 4:30pm @ NFC
Sundays, 12-2pm @ NFC
Sundays, 2:15 - 4:15 @ NFC
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Original Band Extra Jam Time ($15/day/band):
Mondays, 4-6pm @ NFC
Tuesdays, 4-6pm @ NFC
Wednesdays, 4-6pm @ NFC
Thursdays, 4-6pm @ NFC
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| PARENT/ GUARDIAN INFO |
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| Parent/Guardian #1: * |
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| Custodial/Legal Parent/Guardian? |
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| Marital status: |
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| Parent/Guardian #1 Phone: * |
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Do you accept text messages?
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| Parent/Guardian #1 Email: |
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| Parent/Guardian #1 Employer: |
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| OK to call at work? |
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Billing Address *
(Include City, State, ZIP): |
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| Home Address Same as Billing Address? |
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| If Not, Home Address: |
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| Parent/Guardian #2: |
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| Custodial/Legal Parent/Guardian? |
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| Parent/Guardian #2 Phone: |
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| Parent/Guardian #2 Email: |
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| Parent/Guardian #2 Employer: |
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| Ok to call at work? |
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| Emergency Contact: * |
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| Relationship to Child:* |
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Medical Information:*
List any medical conditions, allergies or special conditions that may affect your child's health in the program. Include any medications your child is taking.
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Child's Physician:
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Medical Permission
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I give permission for the staff of the Northeast Family Center to arrange for emergency treatment and to contact family health care provider if guardian is unable to be reached and it is necessary to preserve the health of my child(ren) until such time I/we can be present. I understand that no guarantees have been made to me as to the effect of such treatment on my child's condition. If necessary, the program will arrange for emergency transportation to the nearest medical facility.
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Parent/Guardian Participation Questions:
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I would like to volunteer in to assist with program classes.
I would like to make a donation to support low-income families.
I would like to help out at concerts with merchandise tables, set-up, etc.
I would like more information on how to participate in the AOR Parent Committee.
My employer may be able to help with a donation or sponsorship.
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| Please send me more information on Need Based Scholarships. |
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Income Level:
(TABLE)
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Is your household at or below the U.S. poverty level? (This information is only used for demographic records only. Information is used for grant purposes kept strictly confidential)
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Media Release:
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I give staff permission to use photos, writings, artwork, music, tv appearances and other media for use in promotional materials.
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Policies & Billing Agreement
(CLICK HERE TO READ)
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I have read and agree to the program policies and procedures of the Northeast Famiy Center's Academy of Rock.
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By typing my name below I confirm that:
- I understand that I am submitting my signature.
- The information on this enrollment form is complete and true.
- I agree to update the Northeast Family Center if this information changes.
- I am giving permission for my child to participate in program activities.
- I understand that the NFC does not carry health/accident insurance for my child and that as the guardian, I am primarily responsibly in case of injury where bills are incurred.
- As the parent/guardian, I will work as a partner with my child and program staff to ensure my child is successful.
- I understand my child may be dismissed for failure to follow rules and/or failure to follow general operating procedures of the program.
- I agree to the payment contract presented above.
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| Parent/Guardian Signature: * |
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