Percussion Scholarship Program Parent Questionnaire

Please read the parent letter before filling out this questionnaire.

Applicant (Student) Name *

Parent/Guardian 1 Information

Name *

Street *

City *

State *

Zip *

Email *

Primary phone *

Secondary Phone

Relationship to Student *

Occupation *

Parent/Guardian 2 Information (optional)

Name

Street

City

State

Zip

Primary phone

Secondary Phone

Relationship to Student

Occupation

Household Information

Number of student's siblings *

Commitment

Classes and lessons will be held on Saturdays for 90 minutes. Are you able to accompany your child to Symphony Center each week for their class? *

Yes No

*Please note: It is essential that each student arrive fifteen minutes prior to the starting time of their lesson to allow time for set-up.

Please provide the name and phone number of two adults who can bring your child to class in an emergency situation when you are unavailable.

Emergency Adult Name 1 *

Emergency Adult Name 2 *

Each student will be provided with a practice pad, book, and sticks for practicing at home. Are you willing to share with your child the responsibility for the safekeeping of these items, and any other instruments or materials that may be distributed for practice at home? *

Yes No

Students will be required to practice on their practice pads for at least 45 minutes per day. Are you willing to remind and encourage your child to do this? *

Yes No

It is important that your child practice in the same location each day. Will your child have a time and place where they can practice without fear of disturbing neighbors and without distractions from other children, television, etc.? *

Yes No

Please use the space below to provide any additional information that you feel is important for us to consider when making our final selections. You are welcome to respond in the language you are most comfortable. *