P.A.U.S.E. Interest Form

P.A.U.S.E. Interest Form
Gender:
Name:
Female
Male
Address:
Zip Code:
City, State:
Telephones: Home Phone:
Email Address(es):
Mobile Phone:
Personal Email:
Student Email:
Age:
Grade:
Parent’s Section
Questions about your student
Why would you like your child to join the P.A.U.S.E. after school program?
Has your child ever played a musical instrument?
Yes
No
If yes, what instrument?
How long has he/she studied the instrument?
If no, what instrument(s) would you like for your child to learn (please list three)?
Parental Consent
I give consent for my son/daughter to participate in the P.A.U.S.E. after school music program.
____________________________________
Student (adult) or Parent/Guardian Signature
____________________________________
P.A.U.S.E. Representative Signature
Form 41 Š Rev. 04/07/2009
__________________
Date
__________________
Date
© Copyright 2009
GEORGE S. MAY FOUNDATION FOR THE ARTS
All rights reserved.
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P.A.U.S.E. Interest Form
Genero:
Nombre:
Femenino
Masculino
Direccion:
Zip:
Cuidad, Estado:
Telefono: Casa:
Correo Electronico:
Cellular:
Casa:
Estudiante:
Edado:
Grado:
Seccion de Los Padres
Pregunta para estudiantes
Porque gustaria Participar en el programa de P.A.U.S.E. After School?
Ha jugado usted un instrumento de musica?
Si
No
Si si, que instrumento?
Cuanto tiempo ha estudiado el instrumento?
Si no, que instrumento(s) le gustaria aprender (por favor lista de tres?
Acverdo
Estoy de acverdo en permitir que mi hijo/ hija participle en el programa P.A.U.S.E. despues de la
escuela de musica.
____________________________________
Estudiante (adulto) o Firma del Padre/ Guardian
____________________________________
P.A.U.S.E. Representative Signature
Form 41 Š Rev. 04/07/2009
__________________
Date
__________________
Date
© Copyright 2009
GEORGE S. MAY FOUNDATION FOR THE ARTS
All rights reserved.