Amped Up: Planning A Youth Music Festival (cc)

Amped Up: Planning A Youth Music Festival
March 7, 2022 – May 6, 2022

7:00p-8:00p Tuesdays (virtual via zoom) AND Thursdays 7:00p-8:30p (in person)

Festival Day - May 7, 2022

Plugged In is an inclusive music program that empowers young musicians to make positive change in the world with their music. Plugged In is open to any student regardless of their skill level, race, gender, sexuality, disability, religion, economic status, etc.

Completing our online registration form will take about 5 minutes. Please be aware, there is no option to save an incomplete registration form and return to it at a later time.

Questions marked with a red asterisk are required and must be answered before submitting your registration.

Other

How did you hear about Plugged In?

Student Information

Student Name

First Name

Last Name

Preferred Name / Nickname

Pronouns

Please indicate your preferred pronouns.

Student Birthdate

mm/dd/yyyy

Student Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Student Email

Verify Email

Student Home Phone

Student Mobile Phone

School Name

Current Grade

Enter grade number only

Parent Contact Information

Parent 1 Name (primary contact)

First Name

Last Name

Parent 1 Primary Phone

Parent 1 Email

Verify Email

Parent 1 Employer

Parent 2 Name

First Name

Last Name

Parent 2 Primary Phone

If different than parent 1

Parent 2 Email

Verify Email

Parent 2 Employer

Emergency Contact Information

Whom should we contact in case of an emergency? If registering for the youth program, please provide an alternate contact to the student's parents.

Emergency Contact Name

First Name

Last Name

Emergency Contact Primary Phone

Provide the most reliable number for this emergency contact

Additional Information

What areas does the student have experience in?

Check all that apply

Marketing/PR

Live Sound

Stage Management

Social Media

Booking

Other (please describe below)

Other

What additional relevant skill(s) does the student have?

What are some of the student's favorite musical artists?

In order for the student to have the best possible experience at Plugged In, we strongly encourage you to share information regarding their medical conditions, special needs, behavioral and emotional concerns, allergies, etc.

PLEASE CHECK ALL THAT APPLY - (Information regarding a student may be shared with the Plugged In Directors and their teachers, and will otherwise remain confidential.) .

Autism Spectrum Disorder (ASD)

Attention Deficit Disorder / Hyperactivity Disorder (ADD/ADHD)

Depression

Anxiety / Social Anxiety

Allergies

Physical Limitation

Other

Please identify and describe the student's condition.

Please share any information that would be important for the band teacher to know in working with the student.

Ex: student excels in structured environment, student requires breaks, student is shy, etc.

Would you like to be contacted by the Plugged In Inclusion Committee?

Plugged In is a fully inclusive program. The Plugged In Inclusion Committee acts as a resource for students/families that may need additional supports to ensure their best possible experience.

Yes

Amped Up: Class Schedule

Days and Times

Tuesdays 7:00p-8:30p (in person at Plugged In - 40 Freeman Place. Needham, MA 02492)

Thursdays 7:00p-8:30p (virtually via zoom - zoom link will be provided)

Festival Information

Final show (name to be determined by students)

May 7, 2022

Venue: TBA

Policy

To participate in Plugged In you must read, understand, and agree to the following policies. If you have questions regarding any of the following policies please contact Plugged In directly.

Read New Student Meeting Policy (new students only)

The student and guardian have read and agree to the Release of Liability / Indemnity / Emergency Treatment Agreement

Yes

The student and guardian have read and agree to the Media Release Agreement

Yes

The student and guardian have read and agree to the Code of Conduct Policy

Yes

The student and guardian have read and agree to the New Student Meeting Policy

Reminder: Parent or guardian must attend the new student meeting.

Yes

Payment

$500 - Amped Up Class Tuition

Amped Up: Planning A Youth Music Festival (cc)

Student Information

Parent Contact Information

Emergency Contact Information

Additional Information

Read Release of Liability / Indemnity / Emergency Treatment Agreement

Read Media Release Agreement

Read Code of Conduct Agreement

Read New Student Meeting Policy (new students only)