Fall 2012 Registration Form

Nurturing Expression rough the Language of Music

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(As of 9/4/12)

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Liability Release- Please Read Carefully:

I agree to indemnify and hold harmless Dana V. Music, its officers, employees, agents, consultants, subcontractors, insurers and representatives (collectively Dana V. Music), for any loss, damage, or injury to myself or my property in any way related to my participation in Dana V. Music's programs. This release of Liability applies to me as well as any of my children, personal representatives, assigns, heirs, and next of kin. I authorize Dana V. Music in a medical emergency to seek emergency medical assistance at my expense. Signature of Participant (parent or guardian) Date

I give permission to Dana V. Music to use any photographs, videotape, or other media record of my participation in Dana V. Music Programs for any lawful purpose, without compensation.

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*Information provided here is for Dana V. Music use only. We do not share information with outside sources.

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OFFICE USE ONLY: Payment Type: Intake Initials: Database Initials:
Dana V Music

Amount: Date: Date:

Make checks payable to: Dana V Music

www.danavmusic.com

Mailing Address 901 Front Street, Suite B150, Louisville, CO 80027 (303) 974-5586

_____ _____ _____ _____

CLASS TITLES (Ages) CHOIRS/VOICE Preschool Musical: Once Upon A Lily Pad (3.5-5) Flatiron Youth Chorale: Elementary (5-8) Flatiron Youth Chorale: Intermediate (8-15) Adult Voice Class (16-Adult)

DAY TIME T T T T 1:00-2:00 pm 4:00-5:00 pm 5:00-6:00 pm 7:00-8:30 pm

DATES 9/4-12/4 (no class 11/20) 9/4-12/11 (no class 11/20)

Session I: 9/4-9/25, Session II: 10/30-11/27 (no class 11/20)

COST $195 $190 $190 $100/session

9/4-12/11 (no class 11/20)

_____ Adult Keyboarding

GROUP PIANO/KEYBOARDING
(discount for Preschool Musical parents)

T W Th T T T W W Th M Th T Th W M Th M Th M Th M Th F W F F

1:00-2:00 pm 4:00-4:45 pm 1:00-1:45 pm 4:15-5:00 pm 3:30-4:15 pm 5:00-5:45 pm 5:30-6:15 pm 4:45-5:30 pm 4:00-4:45 pm 4:45-5:30 pm 4:45-5:30 pm 7:00-8:00 pm 7:00-8:00 pm

9/4-12/4 (no class 11/20)

_____ Keyboarding, Level 1 (4-5) _____ Keyboarding, Level 1 (4-5) _____ Keyboarding, Level 1 (5-7) _____ Keyboarding, Level 2 (5-7) _____ Keyboarding, Level 1 (6-8) _____ Keyboarding, Level 1 (6-8) _____ Keyboarding, Level 2 (6-8) _____ Keyboarding, Level 2 (6-8) _____ Keyboarding, Level 1 (8-11) _____ Keyboarding, Level 2 (8-11) _____ Keyboarding, Level 1 (12-Adult) _____ Keyboarding, Level 2 (12-Adult) _____ Youth Eurhythmics (4-6) _____ Youth Eurhythmics (4-6) _____ Youth Eurhythmics (4-6) _____ Youth Eurhythmics (5-7) _____ Youth Eurhythmics (5-7) _____ Pre-Instrumental Eurhythmics (6-8) _____ Pre-Instrumental Eurhythmics (6-8) _____ Music Theory/Eurhythmics (Level 1) (12-Adult) _____ Music Theory/Eurhythmics (Level 2) (12-Adult) _____ Adult Eurhythmics: Movement with a Twist (Adult) _____ Beginning Group Violin/Viola (5-7) _____ Beginning Group Violin/Viola, Level 1 (8-12) _____ Beginning Group Guitar, Level 1 (8-12)
COLLEGE PREPARATORY GROUP INSTRUMENTAL MUSIC FUNDAMENTALS

($230 PSM parents)

$290

9/12-12/12 (no class 11/21) $270 9/13-12/13 (no class 11/22) $270 9/11-12/11 (no class 11/20) $270 9/11-12/11 (no class 11/20) $270 9/11-12/11 (no class 11/20) $270 9/12-12/12 (no class 11/21) $270 9/12-12/12 (no class 11/21) $270 9/13-12/13 (no class 11/22) $270 9/10-12/10 (no class 11/19) $270 9/13-12/13 (no class 11/22) $270 9/11-12/11 (no class 11/20) $290 9/13-12/13 (no class 11/22) $290

9:30-10:15 am 9/12-12/12 (no class 11/21) $182 3:00-3:45 pm 3:00-3:45 pm 4:00-4:45 pm 4:00-4:45 pm 4:45-5:30 pm 4:45-5:30 pm 5:30-6:30 pm 5:30-6:30 pm 7:00-8:30 pm 4:00-4:45 pm 5:00-6:00 pm 5:00-6:00 pm 6:30-8:00 pm 6:30-8:00 pm 9:00am-1 pm 7:00-8:30 pm 9/10-12/10 (no class 11/19) $182 9/13-12/13 (no class 11/22) $182 9/10-12/10 (no class 11/19) $182 9/13-12/13 (no class 11/22) $182 9/10-12/10 (no class 11/19) $182* 9/13-12/13 (no class 11/22) $182* 9/10-12/10 (no class 11/19) $260 9/13-12/13 (no class 11/22) $260 $28/class 9/21, 10/19, 11/16, 12/14 9/12-12/12 (no class 11/21) $235 9/14-12/14 (no class 11/23) $260 9/14-12/14 (no class 11/23) $260 9/12-12/12 (no class 11/21) $260** 9/12-12/12 (no class 11/21) $260** 9/8 (1-day workshop) 9/17-11/5 $90 $300 TOTAL PAID: $ ____________

_____ College Prep. Theory/Eurhythmics, Level 1 (12-Adult) W _____ College Prep. Theory/Eurhythmics, Level 2 (12-Adult) W _____ College Prep. Series II: Career Skills: Business & S _____ College Prep. Series III: Audition Prep. (HS Fr.-Senior) M
Etiquette (HS Freshman-Senior)

*Additional charge for metallophone rental or purchase; **Assessment test required; Rental not included.

Dana V Music

Mailing Address 901 Front Street, Suite B150, Louisville, CO 80027 (303) 974-5586

www.danavmusic.com