The Experience Registration Education Programs Office • 208-578-5464 • N/A Please refer to the REGISTRATION INSTRUCTIONS before completing the information below. Students who have not participated in the past should also submit a teacher recommendation. This may be a letter from your current school or private instructor or you may click here to download a MUSIC TEACHER RECOMMENDATION FORM.STUDENT INFORMATIONName* First Last Other NameGender*MaleFemaleDate of Birth* MM DD YYYY Age*Grade Level as of Fall 2017*School attended in 2016-17Student Email (if applicable) Polo Shirt Size*youth smallyouth mediumyouth largeadult smalladult mediumadult largeadult extra largeadult XXLPARENT/GUARDIAN CONTACT INFORMATIONParent/Guardian name* First Last Relationship to child if not parent (aunt, uncle, etc)Mailing Address (street or P.O. Box)* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home phone*Cell phone or alternate phoneParent Email* MUSICAL INFORMATIONINSTRUMENT OR VOICE REGISTERING FOR (select one)*violinviolacellostring basspianofluteclarinetoboebassoonalto saxtenor saxfrench horntrumpettrombonetubapercussionvoiceharpList any other instruments you have studied seriously and length of studySchool Music Teacher Name (if applicable)School Music Teacher Phone numberSchool Music Teacher Email Private Music Teacher Name (if applicable)Private Music Teacher Phone numberPrivate Music Teacher Email Years of Experience on Primary Instrument or Voice*What Scale, Etude or Method book are you currently working in?Work Samples Please post your performance on YouTube and provide the link below (if applicable).Performance 1Performance 2Performance 3LIST TWO PIECES YOU ARE CURRENTLY WORKING ON ALONG WITH THE COMPOSERPiece #1 titlePiece #1 composerDid you perform this piece?YesNoPiece #2 titlePiece #2 composerDid you perform this piece?YesNoTypes of training you have received (check all that apply)* Suzuki Classical Orchestra Concert Band Concert Choir Jazz Chamber Music Vocal Ensemble Other Indicate Level of Suzuki Training reachedOther trainingHave you attended the SMW in the past*YesNoIf you attended previous SMW camps, what orchestra group or section were you in (Example: SVYO 2nd violin or Piano group 3)If you attended previous SMW camps, what group do you think you should be in this summer? ________VOICE STUDENTS ONLY Check program you are applying for*Concert Choir (ages 8-14)Chamber Singers (ages 15 and up)OTHER OPTIONSI would like to audition for the Soloist Recital (see registration instructions for more information)yesnonot sure, but maybePlease list piece you will audition with and composerSign up for private lessons - Indicate which instrument or voicePrivate lessons are optional.Note: additional charge will apply, see registration instructions for more information. Private lesson fee30 min (fee $35)60 min (fee $65)I would like to I would like to sign up for the following Electives (electives are optional) Chamber Music Experience Intro to Composition Intro to Improvisation Piano for non-piano students Viola for Violin players Opera Workshop Experience(High School Singers only) I would like to volunteer (check all that apply, see registration instructions for more information) Parent volunteer Provide cookies or snacks Be a housing host for a student musician PHOTO RELEASE*I understand that images or videos of my student may be taken during the workshops and recitals. These images are the property of the SVSS and may be used in promotional materials. The SVSS may use images of my student.YesNoSCHOLARSHIPS I am interested in a scholarship. Note: Please fill out Scholarship Application when registration form is completed. FEES Full Materials and Registration fee (non-refundable): $90 Private lessons (optional): $35 (half-hour lesson) $65 (full hour lesson) Experience fees are due June 16, 2017 you may pay on-line with a credit or debit card or mail a check to SVSS Sumer Music Institute, P.O. Box 3956, Hailey ID 83333 If you are applying for financial assistance through our scholarship program, please pay only the $30 registration deposit at this time. You will be notified by early June if your request was approved. Pay Fees Online Pay Fees Online Online Fees $30 Experience Non-Refundable Deposit (you will be billed for remaining fee in early June) $90 Experience Full Registration and Materials Fee (Non-Refundable) $35 half-hour private lesson (optional) $65 hour private lesson (optional) $90 donation (underwrite a SMI scholarship) $20 donation (help provide snacks for students during the week) Other $30 Experience Price: $30.00 $90 Experience Price: $90.00 $35 Private Price: $35.00 $65 Private Price: $65.00 $90 Donation Price: $90.00 $20 Donation Price: $20.00 Other Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.