SUSPENDED FORM

Welcome to Advanced Suzuki Institute Online Enrollment

Student Name

Birthdate

Gender

Male Female

Address

Instrument

Is this student an Advanced Institute student or a Young Sibling student?

Please register Young Siblings (Books 1-3) using the Young Sibling Registration Form.

Which best describes your music study background?

Advanced Suzuki book 4-10 Post Book 10 Advanced Suzuki Advanced Non-Suzuki concerto level

Viola for Violinists: Is viola your secondary instrument? Please select all options that apply to you. Students new to viola, do not select these options, instead select "viola for violinists enrichment class

I am interested in Viola technique class‎ I would like to play viola in my chamber group‎ I would like to play viola in orchestra‎

Current Book

Current Piece

Current Piece Composer

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FREE Commemorative T-Shirt

Purchase Additional T-Shirt

Parking Day Pass 4 pack

$18.50‎

Chamber music is open to Violin Book 5 and up and Cello or Viola Book 4. Chamber music students have chamber coaching instead of Suzuki Repertoire class.

Students in book 6 and above are highly encouraged to enroll.
Non-Suzuki students should be at or above these levels:
Violin: Accolay Concerto
Viola: Concerto in G Major, G.P. Telemann
Cello: Sonata in E minor, Opus 1 No. 2 by Marcello

All Chamber music students, Suzuki or non-Suzuki, must submit a video of a chamber music or non-chamber music piece, selected and approved by their teacher, to ensure acceptance and placement in a quartet with members of similar level and age. Music is mailed in advance. Pre-formed groups are allowed, contact us for details.

Are you applying for the Chamber Music Program?

Yes $125 No

How will you submit your Chamber placement video?

Upload directly now Provide public YouTube link now Submit Audition form later

Upload Video

Uploading, please wait...

Upload

YouTube Link

Chamber Audition Piece Name

Opus #

Composer

Tempo e.g. Allegro

Submit my Chamber Video Later

I agree to submit my video before June 1, 2017

All Advanced Students are enrolled in one enrichment course. Students may select to enroll in two enrichment courses (resulting in a full 6 hour class day with no free periods) for an additional $50.

How many enrichment courses would you like to enroll in?

One (Included) Two (Additional $50 tuition)

Please rank the following enrichment courses in order of preference. Students will be by preference and ability level. We make every effort to give students their first choice.

1
2
3
4

Jazz and Improvisation

Pop and Improvisation

Music Theory and Composition

Viola for Violinists

All students (Advanced and Young Sibling) may submit a video audition for consideration to participate in a student Honors Recital. You may submit a video with this application, submit a YouTube link with this application or submit your video on our Audition Submission form before June 1, 2017.

Would you like to audition for the Honors Recitals?

Yes No

How will you submit your Honors Recital audition video?

Upload directly now Provide public YouTube link now Submit Audition form and video later

Recital Audition Piece Name

Opus #

Composer

Tempo e.g. Allegro

Duration in minutes

Upload video

Uploading, please wait...

Upload

YouTube Link

Submit my Recital Video Later

I agree to submit my video before June 1, 2017

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Primary Parent Information -- If staying in the Family Dorms, the primary parent is the parent staying in the dorm.

Parent Name

Relationship

Mother‎ Father‎ Guardian‎

Email

Phone

Secondary Phone

Additional Parent Information

Additional Parent Name

Relationship

Mother‎ Father‎ Guardian‎

Email

Phone

Emergency Contact Information (Non-parent, please)

International numbers: Please provide international phone numbers in the comment section at the end of this form if you are unable to enter them above... We apologize for the inconvenience.

Emergency Contact Name

Phone

Relationship

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Medical Insurance Provider

Group Number

Policy Number

Doctor's Name

Doctor's Phone Number

Medical conditions, food allergies, dietary restrictions

Medical Treatment Informed Consent

I grant permission for a nurse, health center, or hospital staff to administer any necessary aid immediatley to myself or my child(ren) referenced in this application should s/he, they, or me become sick or injured whlile atending the SANC Advanced Suzuki Insititue, and in the case of my chld(ren), to do so without having to wait until I am contacted. In the unlikely event of physical injury resulting from your participation in this program, necessary medical treatment will be provided to you and/or your children and billed as part of your medical expenses. Costs not covered by your health care insurer will be your responsibility. Also, it is your responsibility to determine the extent of your health care coverage. There is no program in place for other monetary compensation for such injuries. However, you are not giving up any legal rights or benefits to which you are otherwise entitled.

I grant permission

Yes

Suzuki Association of California-SANC Video Release

VIDEO AND PHOTO RELEASE - During SANC events, your child(ren) may be included in candid photographs or videos. Please read the following Release and indicate your authorization or denial of waiver. Note that no names are ever used with the photos:

For valuable consideration I here I hereby give to the Suzuki Association of Northern California (SANC) the absolute and irrevocable right and permission with respect to the photographs or videos that have been given to SANC or taken by SANC’s representatives of my minor child in which s/he may be included with others: To use, re-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter known, and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion, advertising and trade.

I hereby release and discharge SANC from all and any claims and demands ensuing from or in connection with the use of the photographs, including any and all claims for libel and invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees and assigns of SANC as well as the person(s) for whom SANC took the photographs or provided them. It shall stay in effect until SANC receives written notice that permission has been withdrawn. I have read the foregoing and fully understand the contents hereof. I represent that I am the [parent/guardian] of the above named model(s). For value received, I hereby consent to the foregoing on his/her behalf.

I grant permission

Yes No

STANFORD LIABILITY WAIVER - Stanford University requires camp participants to sign a liability waiver. Information and a link to the waiver can be found here: Stanford Liablity Waiver Information and Stanford Liability Waiver. Stanford requires acceptance of the waiver to participate at camp. Parents will be requested to sign a form during camp registration.

I have received and agree to the Stanford Liability Waiver.

yes

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Student's Teacher Information.

Private Teacher's Name

The email address you provide is used to send the electronic Student Recommendation form to you teacher. Please ensure this address is correct so we can continue to process your registration.

Private Teacher's Email

Phone

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Housing and Meals

The family dorm is FULL. Please email asi@suzukinorcal.org to be added to the waitlist. Stanford is looking for an additional building to house us. We have 10 teen dorm slots remaining! The teens (age 12+) are housed in a separate building with 24 hour counselor supervision.

Key deposits will be returned within 2 weeks after institute.

Meal plans are INCLUDED with Dormitory purchase

Our commuter lunch and dinner program is available for pre-purchase. Many dietary options are available including gluen-free, allergen-free and vegan.

Teen Dorm

Teen Dorm Double, Meals and Supervision Fee Included $575+ $135 deposit‎

Roommate request (optional)

Would you like to purchase additional teen nights before or after the institute?

Yes No

Additional Teen Nights

Saturday Additional night BEFORE institute (no meals) Supervision Fee Included $75‎ Thursday Additional night AFTER institute (no meals) Supervision Fee Included $75‎

Family Dorm

Room and Meals One Adult and Child same room $900+$135 deposit‎ Room and Meals Adult Single $550+$135 deposit‎ Room and Meals Adult Double $475+$135 deposit‎ Room and Meals Extra Child staying with "Adult and Child" $425‎

Would you like to purchase additional family nights before or after the institute?

Yes No

Family Dorm Additional Nights

Saturday Additional Night BEFORE (no meals) institute Youth with Adult $135‎ Thursday Additional Night AFTER (no meals) institute Youth with Adult $135‎ Saturday Additional Night BEFORE (no meals) institute Adult single $90‎ Thursday Additional Night AFTER (no meals) institute Adult single $90‎ Saturday Additional Night BEFORE (no meals) institute Adult double $75‎ Thursday Additional Night AFTER (no meals) institute Adult double $75‎ Saturday Additional Night BEFORE (no meals) institute Additional child $60‎ Thursday Additional Night AFTER (no meals) institute Additional child $60‎

Commuter Lunch: Would you like to purchase communter lunch plans? $60 per person Monday-Thursday. Individual tickets sold on campus

Yes No

How many lunch plans?

Commuter Dinner: Would you like to purchase commuter dinner plans? $80 per person Monday-Thurs. Individual tickets sold on campus

Yes No

How many dinner plans?

Food allergies or dietary restrictions

Please specify other food allergy or dietary restriction.

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Electronic Signature Agreement: By selecting the "I Accept" button, you are signing this registration electronically and that you have submitted information to the best of your knowledge.

Teacher Recommendation: REQUIRED Once you submit your application, notify your teacher that your application has been submitted. Your teacher will receive an email from us with a link to an online student recommendation form. Your application is not complete until this form has been completed and submitted by your teacher.

Parking: If you will be parking a car, you must purchase a parking permit for $4.50 from the Institute Office on campus. General parking meters are also available. Parking is free on Sunday.

Payment: Payment must be completed during registration for your child to be registered and must be paid before the early bird deadline (April 1, 2017) or regular deadline (June 1, 2017) to receive early bird or regular tuition rates. Please email us at asi@suzukinorcal.org if you need help using PayPal. PayPal will accept your credit card, debit card and electronic checks. An account is not necessary. If you must pay by paper check, complete form on your computer, print, then send competed form to the contact below. Do not print out a blank form to complete. Make checks payable to SANC. There is a $35 charge for returned checks.

Refunds: If you decide to cancel your registration, notify the ASI Admin Office in writing. Prior to June 1, 2017, there is a $150 non-refundable cancellation fee per participant. Due to faculty and travel commitments, applicants who cancel after June 1, 2017 forfeit all fees including Room and Board, meal plans and parking.

Solo and Chamber Music Audition recordings: If not submitted with this application, they must be submitted no later than June 1, 2017.

I have read and agree to the above information, including refund policy.

Yes‎

Notes: Please let us know any additional information or questions

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