Saturday Conservatory of Music Online Registration Online Registration School * Select School Saturday Conservatory of Music Personal Detail Terms * Fall Winter Spring Enrollment Status * New Returning If returning student, how many year(s)? 1 2 3 4 5 Other Student Name * Gender * Male Female Other Birthday * Phone Number Student's Email * Address * City * State * Zip Code * Student's School * Student lives with: Both Parents Mom Dad Shared Custody Guardian Other Parent / Guardian Detail Parent / Guardian Name * Parent / Guardian Phone * Parent / Guardian Email * Parent / Guardian Address (if different from student) Parent / Guardian Occupation, Title, Employer Student Health Detail Student's Health Issues Allergies, Asthma, Special Needs, etc. Emergency Contact? Person Authorized to care for Student in Emergency (if other than those listed above) Relationship Phone Number Doctor's Name Doctor's Phone Preferred Hospital (if no family doctor) Additional Detail MEDICAL and LIABILITY RELEASE * I absolve and hold harmless the Saturday Conservatory of Music and Community Partners, the staff, and Board of Directors from any liability which may result from the participation of any minor in my legal custody. If the participant is a minor, I give my permission for any necessary emergency medical treatment. I understand the Saturday Conservatory of Music and Community Partners have no obligation to supervise my children outside of the classroom. I release their staff and Board of Directors from any liability resulting from any lack of supervision of my child at the completion of their classes. Yes No PUBLICITY RELEASE * Students involved in instruction at the Saturday Conservatory of Music, a project of Community Partners, may be photographed and/or videographed and such media may be used for educational purposes, and to publicize programs at the Saturday Conservatory of Music, a project of Community Partners. I permit the use of any such photos or video of my family (or guardians of the minor) and my child. Yes No PARENT RESPONSIBILITY * As the parent/guardian of the above named student(s), I assume financial responsibility for any and all damage, including due to misuse, abuse and neglect, and any and all loss, including due to theft, of or to any and all Saturday Conservatory of Music, a project of Community Partners, and San Gabriel Unified School District property, including, but not limited to, repair and/or replacement costs of affected instrument(s), equipment and/or premises. Yes No Ethnicity African American Asian or Pacific Islander Caucasian Hispanic/Latino Native American Other Home Language English Chinese Vietnamese Korean Spanish Tamil Thai Hindi Other How did you hear about our program? Family/Friend Website Flyer Outreach Event Current Teacher Other Number of Brothers Age(s) Number of Sisters Age(s) City of Birth Has the Student studied music before? Yes No If yes, how long and where? Instrument Additional Instrument? Do you have the instrument you wish to study? Yes No Student currently taking private lessons? Yes No Sibling Discount - Not applicable to those with discount/scholarship ($5 off per one student enrolled in our program & siblings must be concurrently enrolled in our program for discount to apply). Full Name of 1st sibling at SCM Full Name of 2nd sibling at SCM Full Name of 3rd sibling at SCM Full Name of 4th sibling at SCM Admission Detail Main Class * Select Class Section * Select Section Upload Photo Class 1 Select Class Section 1 Select Section Class 2 Select Class Section 2 Select Section Class 3 Select Class Section 3 Select Section Login Detail Username * Login Email * Password * Submit