Amped Up: Planning A Youth Music Festival (c)

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 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

Scholarship

Plugged In's scholarship fund was created to meet the need of those students who are interested in participating in Plugged In, but whose family may not have the financial resources to pay full tuition. Plugged In's goal is to ensure music instruction and a welcoming community to all young musicians. To help determine a family's need for scholarship applicants must provide the requested financial documentation. Applicants are also able to share and factor in any extenuating circumstances that may effect their ability to pay tuition. Examples of extenuating circumstances can include but are not limited to, limited income, sudden death or abandonment of the primary provider, single parent households, etc. Applicants may be asked to provide additional documentation to illustrate their need to qualify such as recent paystubs, letters of reference, etc. Plugged In is committed to ensuring all musicians have access to our programming.

I wish to apply for scholarship for the student.

Yes

Number of Family Members

How many people are in your immediate family?

Please enter your family's combined gross income.

This is typically line 37 on your IRS tax form 1040.

Please provide us with a copy of your most recent years IRS form 1040.

.pdf and .jpg file types accepted. Upload limited to 10MB. If you are unable to provide an electronic copy of your IRS 1040 form please contact Plugged In for support.

Please describe any extenuating circumstances that dramatically effect your listed gross income.

Examples of extenuating circumstances can include but are not limited to - sudden death or abandonment of the primary provider, single family households, care of child with a disability or aging family members, etc.

Scholarship Sliding Scale

Plugged In Scholarship Sliding Scale SU20 Band Class 4-Week.jpg

Please select your level of scholarship

Please choose the appropriate scholarship level for your family based on the Sliding Scale Chart above. If you have described an extenuating circumstance above please select the scholarship level that best fits your current circumstance. You will be contacted if Plugged In requires additional information regarding your choice of scholarship level. * If you wish to submit payment for any remaining tuition fee after scholarship using a credit/debit card please contact Plugged In for an electronic invoice.

Partial Scholarship - $320 tuition owed

Partial Scholarship - $240 tuition owed

Partial Scholarship - $160 tuition owed

Partial Scholarship - $80 tuition owed

Full Scholarship - $0 tuition owed

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

Amped Up: Planning A Youth Music Festival (c)

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)