Student Registration Form First Name (required) Last Name (required) Date of Birth (required) Gender (required) ---MaleFemale Instrument (required) Suzuki Book Number (required) Current Piece (required) Polished Piece (required) Orchestral Experience (string students only) InstituteYouth OrchestraSchoolOtherNone Private Teacher's Name Private Teacher's City Private Teacher's State Private Teacher's Phone Number Students must be accompanied by an adult at all times during the Institute. Local students ages 12 and above may attend without an adult. Please indicate this on form. Parent/Guardian Attending Institute Address (required) City (required) State (required) Zip Code (required) Your Email (required) Phone Number (required) Alternate Phone Number T-Shirt Size (included in tuition) (required) ---Child XSChild SChild MChild LAdult SAdult MAdult LAdult XLAdult XXL In addition to daily masterclasses and group classes, each full day student will choose two elective classes. Choose Your First Elective Class from the List Below (required) ---ArtIntro to Suzuki RecorderFiddleOrffWorld DrummingModern GuitarChamber MusicImprovisation/CompositionMusic Theory GamesStory-boundOrchestraJazz ViolinFamily ChorusConductingGraphic Arts Photo Imaging Choose Your Second Elective Class from the List Below (required) ---ArtIntro to Suzuki RecorderFiddleOrffWorld DrummingModern GuitarChamber MusicImprovisationCompositionMusic Theory GamesStory-boundOrchestraJazz ViolinFamily ChorusConductingGraphic Arts Photo Imaging In case one of the obove Elective Classes is not available, please choose an alternate class (required) ---ArtIntro to Suzuki RecorderFiddleOrffWorld DrummingModern GuitarChamber MusicImprovisationCompositionMusic Theory GamesStory-boundOrchestraJazz ViolinFamily ChorusConductingGraphic Arts Photo Imaging Siblings of a participating student can enroll in elective classes ($75 per week for each sibling). Please list below the name, age, gender and choice of class for each sibling you wish to enroll. STUDENT FEE PAYMENT - T-shirt & Sunday Pizza Dinner & Monday are included with any student registration - Young beginner students (3-5 years old) may register for Half Day - 3 classes per day Early Bird Discount (-$25)Student Registration Fee ($75)Family Registration Fee ($125)Full Day Tuition ($425)Half Day Tuition ($285)Pre-institute lessons-Book 1 ($60)Pre-institute lessons-Book 2 ($80)Pre-institute lessons-Book 4 ($80) Number of Additional Pizza Dinners ($8 each) Number of Cook-out Dinner Tickets ($5 each) Additional T-Shirts ($15) - Please list Number and Size Siblings Classes ($75 per week for each sibling) - Please list Name, Age and Number of children and classes I have read and understand the Memphis Suzuki Institute Policies and I agree to abide by the regulations stated there. I accept complete responsibility for the charges and fees that may be incurred. Please note that you will not be able to submit the form without first checking the box above to accept our policies. You may view our policy by clicking on this link: http://suzukimemphis.com/policies/ Once you click the "Submit Form" button, we will receive your form for review. You will receive a PayPal invoice within 24 hours. The invoice will be sent to the email address you provided. Thanks!