Plugged In Band Program · MUSE @ Plugged In

Registration

Student Information

Student Name

*

First Name

Last Name

Preferred Name / Nickname

Gender

*

Preferred Pronouns

*

Pronouns

Please indicate the student's preferred pronouns below.

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

Parent Contact Information

Parent 1 Name (primary contact)

First Name

Last Name

Parent 1 Primary Phone

Is parent 1 primary phone a cell or home phone?

Cell

Home

Parent 1 Email

Verify Email

Parent 1 Employer

Parent 2 Name

First Name

Last Name

Parent 2 Primary Phone

If different than parent 1

Is parent 2 primary phone a cell or home phone?

Cell

Home

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

Band Placement Information

Student's Primary Instrument

*

Other

*

Student's Primary Instrument

What additional instrument(s), if any, is the student interested in playing?

*

Check all that apply

None

Guitar

Bass

Drums

Keyboard

Vocals

Other

*

What additional instrument(s), if any, is the student interested in playing?

How long has the student been playing their primary instrument?

*

Is the student self-taught or have they had formal lessons?

*

Is the student open to singing in their band?

*

Yes

No

What style of music does the student prefer most?

*

Other

*

What style of music does the student prefer most?

What are some of the student's favorite bands?

*

In order for the student to have the best possible experience at Plugged In, we strongly encourage you to share information regarding medical conditions, disabilities, 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)

Down Syndrome

Attention Deficit Disorder / Hyperactivity Disorder (ADD/ADHD)

Depression

Anxiety / Social Anxiety

Allergies

Physical Limitation

Other

*

Please identify and describe the student's condition.

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

No

Would you like to be part of the Plugged In Inclusion Committee

Yes

No

Please share any additional information that would help with band placement.

Ex: prefers to be with older students, prefers to be with low-key performers, etc.

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.

Band Class Location Options

Summer 2023 session MUSE @ Plugged In band classes are offered at Plugged In at 40 Freeman Place in Needham or at The Record Company in Boston (https://www.therecordco.org/).

Please select the location that is best for the student for band class.

*

Band Class Scheduling

Please check all the time slots which the student is available. To ensure the best possible band placement students are encouraged to provide as many time slot options as possible.

If there are scheduling or placement questions, please email info@pluggedinband.org. Thank you.

Band Class Scheduling

Mondays/Wednesdays 5:00p - 6:00p

Mondays/Wednesdays 7:00p - 8:00p

Tuesdays/Thursdays 5:00p - 6:00p

Tuesdays/Thursdays 7:00p - 8:00p

Summer 2023 Session Benefit Concert

Plugged In holds a benefit concert at the end of every session. The benefit concert acts as a recital where students perform the sets they’ve been learning for an audience. In addition to the performance the benefit concert also gives students a unique opportunity to give back to the community. Each benefit concert raises funds and awareness for a charity chosen by the students. The concert shows students they can make positive change in the lives of others by doing something they love, like playing music.

For the Summer Band Class Session, the benefit concert will be on Friday, August 4.

Benefit Concert Scheduling

We do not accept concert scheduling requests. All students must be able to perform when scheduled.

Participation - More Than Music

Our community thrives on mutual support and involvement in and out of band class. It is common for students to participate in more than one band, volunteer to help other students, support other programmatic pieces of Plugged In, etc. There are many ways that students and families can get more involved in Plugged In, all of which bring our community closer together.

Is the student interested in volunteering at Plugged In?

Plugged In is always looking for skilled adult volunteers for various roles. If you would like to be contacted about volunteering at Plugged In select "yes" and our Volunteer Outreach Coordinator will contact you.

Yes

No

Student Volunteer Tasks

Please check all that apply Marketing (hanging up flyers, community emails, social media, etc.)

Marketing (hanging up flyers, community emails, social media, etc.)

Performance Production (transporting, setting up, and breaking down equipment, live sound)

Plugged In Board of Directors

Plugged In Committee(s) (Facilities, Finance, Inclusion, Development, etc.)

Student Volunteer Skills

Do you have a particular skill that you would like to volunteer? ex: graphic design, book keeping, event planning, etc.

Is the parent interested in volunteering at Plugged In?

Plugged In is always looking for skilled adult volunteers for various roles. If you would like to be contacted about volunteering at Plugged In select "yes" and our Volunteer Outreach Coordinator will contact you.

Yes

No

Parent Volunteer Tasks

Please check all that apply Marketing (hanging up flyers, community emails, social media, etc.)

Marketing (hanging up flyers, community emails, social media, etc.)

Performance Production (transporting, setting up, and breaking down equipment, live sound)

Plugged In Board of Directors

Plugged In Committee(s) (Facilities, Finance, Inclusion, Development, etc.)

Parent Volunteer Skills

Do you have a particular skill that you would like to volunteer? ex: graphic design, book keeping, event planning, etc.

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.

Yes

The student and/or guardian has read and agreed to the Media Release Agreement

*

Yes

The student and/or guardian has read and agreed to the Code of Conduct Policy

*

Yes

The student and/or guardian has read and agreed to the Band Configuration Policy

*

Yes

The student and/or guardian agree to participate in a "new student meeting" prior to the start of the session.

*

If a student is 18 years old or younger a parent or guardian must attend the new student meeting.

Yes

Payment

*

$300 - MUSE @ Plugged In Summer 2023 Band Class

MUSE @ Plugged In - Summer 2023 (cc)

MUSE @ Plugged In
Evening Band Class Summer Session
July 10 - August 4

Final Concert August 4, 2023

Registration

Student Information

Parent Contact Information

Emergency Contact Information

Band Placement Information

Participation - More Than Music

Read Release of Liability / Indemnity / Emergency Treatment Agreement

Read Media Release Agreement

Read Code of Conduct Agreement

Read Band Configuration Policy

Read Attendance Policy

MUSE @ Plugged In - Summer 2023 (cc)

MUSE @ Plugged InEvening Band Class Summer SessionJuly 10 - August 4

Final Concert August 4, 2023

Registration

Student Information

Parent Contact Information

Emergency Contact Information

Band Placement Information

Participation - More Than Music

Read Release of Liability / Indemnity / Emergency Treatment Agreement

Read Media Release Agreement

Read Code of Conduct Agreement

Read Band Configuration Policy

Read Attendance Policy

MUSE @ Plugged In
Evening Band Class Summer Session
July 10 - August 4