| STUDENT Name |
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| Surname |
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| Address |
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| City |
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| Prov/State (2 letter abbreviation) |
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| Postal/ZIP |
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| Country |
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| Phone |
NOTE: format must be like 999-222-4444 |
| E-mail (input carefully) |
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| Gender |
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| Age (on August 1, 2008) |
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| INSTRUMENT |
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| NEWEST SUZUKI PIECE (Book & Title/Mvt.) |
NOTE: If Bk. 1, state whether (HS) Hands Separately or (HT) Hands Together. |
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| Parent Name/Surname |
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Other Parent/Chaperone attending the Institute:
Name/Surname |
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| Do you have more than one student registered? |
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| OK for private lessons with different teachers at same hour? |
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List of siblings that are registered:
Name(s)/Surname(s) |
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| 2. YOUR HOME TEACHER |
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| Teacher Name/Surname |
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| Address |
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| City |
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| Prov/State (2 letter abbreviation) |
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| Postal/ZIP |
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| Country |
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| Phone |
NOTE: format must be like 999-222-4444 |
| E-mail |
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| 3. READING LEVEL & PIANO DUET EXPERIENCE |
Can use the DAMPER PEDAL without a pedal box?
Can reach an octave comfortably?
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| Current Reading
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Book
Page |
| Please name the most recent non-Suzuki piece you have learned: |
Composer/Title
Book Series
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| Duets or 2-Piano pieces studied in the past 2 years (Students Bk. 2 and up): |
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| 4. IMPORTANT INFORMATION |
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| DAYCARE IS REQUIRED
Ages of children for daycare.
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| I CAN BE A VOLUNTEER DURING THE INSTITUTE |
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| Name |
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| I can help with:
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Other
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| Photos of my child may be used for publicity including the website. |
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| LIABILITY (Registration cannot be completed without your agreement to accept liability.) |
IMPORTANT! By registering my child for this institute, it is understood and agreed that SOSI Inc. bears no liability while my child attends SOSI. I take full responsibility for my child and his or her activities during SOSI. I AGREE TO THE ABOVE. |
| 5. SOLO RECITAL INFORMATION |
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| Piece to be performed (polished, preferably played previously in a recital): |
Composer
Title/movement
Suzuki Book (if applicable) |
| 6. CHOOSE ONE OF THESE PROGRAMS:
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Adult Private Lesson |
| 7. OPTIONAL CLASSES (only ONE choice in addition to Operetta) |
Operetta
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| 8. REGISTRATION FEE (per family) |
Determined by date that you submit this application.
By May 1, 2008: $30 CDN or US; After May 1, 2008: $75 CDN or US |
| 9. TAX-DEDUCTIBLE DONATIONS |
I would like to contribute to the SOSI Bursary Fund... $
I would like to contribute to the SOSI Endowment Fund... $
Teacher name (if being honoured)
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| 10. SOSI MEMBERSHIP (join or renew) |
I would like to be a 2008-9 member of SOSI ($10 CDN or US)
My name
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| When your information is complete, please click SUBMIT below.
WARNING: If you click Completely CLEAR this Form, all your entries will be erased.
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We will contact you to confirm your application and the amount due.
If you have any questions about fees, please contact:
Tracy Jewell, administrative coordinator
Speedvale Postal Outlet
P.O. Box 26058
Guelph, ON N1E 6W1
CANADA
Phone (519) 824-7609
Fax (519) 824-7874
E-mail: sosi@artset.net
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