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1 Page 1 of 6 In order to fully process your registration, you must complete this form in its entirety. Contact Information: Student Name: Grade in school : Date of Birth : / / Gender: School: Student Health Concerns (allergies, medical conditions, medications): Parent 1 Name: Parent 1 Home Phone: Cell Phone: Work Phone Employer: Job Title: Parent 2 Name: Parent 2 Home Phone: Cell Phone: Work Phone Employer: Job Title: Mailing address where all Portland Conservatory communications should be mailed: Name Address City State Zip Ethnicity: Although it is not required, the Portland Conservatory of Music benefits greatly by this voluntary supply of students ethnic information. PCM is required to report specific information to state, private, and government grant programs, in an effort to provide financial aid and scholarship funds to our students. All information is completely anonymous and will not be shared or sold to any outside parties. Please indicate all that apply for you or your child: White Black/African American Asian American Indian/ Alaskan Indian Native Hawaiian/ Other Pacific Islander American Indian/ Alaskan Native & White Asian & White Black/African American & White Other American Indian/Alaskan Native & Black/ African American Hispanic Latino Check if you are: 62+ years Female Head of Household Disabled

2 Page 2 of 6 In order to fully process your registration, you must complete this form in its entirety. How did you learn about the Portland Conservatory of Music? Down East Magazine Forecaster Portland Press Herald Sunday Telegram Portland Press Herald Other Advertising. Please Specify Online Search Engine Facebook Constant Contact newsletter Community Event. Please Specify Recommended by Friend. Who? Liability Waiver: The Portland Conservatory of Music would like permission to use photos, videos, and/or audio recordings, of you and/or your child, in promoting our school. This information would be used solely for promotion and advertising for PCM. These items may be used online, in news print, advertising in magazines, and in fundraising and promotional brochures. Please consider giving permission for the school to use photos, videos, and/or audio recordings of you and/or your child. PCM may use my and/or my child s photos, videos, and/or audio recordings for promotional and fund-raising purposes. Yes No Please check one. Parent please sign here if student is under age 18 Volunteer Opportunities: Throughout the school year we often have luncheons, recitals, concerts, mailings, etc., where we could really use a helping hand. If you would like to be a volunteer please complete the following and circle the appropriate choices: Educational Background: Occupation: Hobbies, Interests, Skills: (music, teaching, playing an instrument, graphic design, computers / technology, photography, website design, development, carpentry, etc.) Other Is there a particular type of volunteer work in which you are interested? (tabling at an event, grant writing, publicity, concert or reception set-up / tear down, transporting students, ushering at concerts, building maintenance, childcare, developing program notes, helping with mailings, archiving music, host family, creating a scrapbook of past events) Other Do you own an automobile? How many passengers can you fit in your vehicle? Is there a group you would particularly like to work with? (adults, children, teens, seniors) At what times are you interested in volunteering? (weekends, weekdays, days, evenings, am flexible) Are you available year-round? Seasonally from: to:

3 Page 3 of 6 I have read and understand the Registration Policies on page 5. Please sign here: Private Lessons: Student Name: Instrument: Years Studied Previous Teacher: PCM Teacher: 30 Minute Private Lessons, Full Semester is 10 Lessons at $33.00 each. $ (This includes Suzuki Lessons) 45 Minute Private Lessons, Full Semester is 10 Lessons at $49.50 each. $ (This includes Suzuki Lessons) 60 Minute Private Lessons, Full Semester is 10 Lessons at $66.00 each. $ (This includes Suzuki Lessons) Payment Information: Discount Allowed - = Financial Aid Awarded - = Extended Lesson Scholarship Awarded - = Registration Fee: $15 per semester + $10 for 2 nd, 3 rd, etc. family members Subtotal: **Payment Plan Fee:$ (charged once every semester) Total Fees: = Total Due: **All Payment Plan installments will be automatically charged to your credit/debit card, on the dates listed below, in three installments. The first payment due at registration, which includes all fees and 1/3 of tuition. Second payment processed on June 30, Third & final payment processed on July 28, 2014 **I agree to the payment plan Signature Payment Method: Check # Cash V/MC AMX Disc Card # Expiration Date: / C. V. V. # Name on Card: Signature:

4 Page 4 of 6 THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK

5 Please read and then sign in the appropriate location on page 3 of this registration form, stating that you have read and understand the policies listed below. Registration Policies Each student must register for each semester prior to the start date of that semester. Tuition Policy The Portland Conservatory offers a multi-family member discount, on private lessons only. If more than one person in an immediate family is taking private lessons at PCM, the discounts will be as follows: First student in family pays full tuition for private lessons. Second student in family receives 5% off tuition for private lessons. Third and additional family members receive 10% off tuition for private lessons. Registration Fee & Payment Plan Policy When registering, the Conservatory charges a registration fee of $15 for the first student and $10 for each additional student, per family, per semester. All fees and tuition must be paid prior to the first lesson each semester. If payment plan is requested, it is available in three installments by credit card or debit card only. A $15 payment plan fee will be added to your tuition each semester. Registration fees and payment plan fees are non-refundable. Once a student is registered and tuition is paid in full or by payment plan, that student will receive a Membership Card that is to be presented to the teacher of each of the classes and/or lessons the student has registered for, at the first lesson or class, for the current semester. Tuition Refund Policy Students registering mid-semester will pay a pro-rated fee from the date lessons begin. Students withdrawing from lessons can do so until the 4th paid lesson of that semester, however no refunds will be given after the 4th paid lesson of that semester. * There are no refunds for classes or ensembles. * The Conservatory reserves the right to cancel classes if the enrollment is below an acceptable minimum. In that case full tuition and registration fees will be refunded. Attendance Policy Students are expected to attend all scheduled lessons. Teachers are required to make up only one missed lesson per semester, during the Make-up Week at the end of each semester, or by special arrangement. All private lessons missed because of an instructor s absence or school closing will be made up. Any additional lessons missed by the student, for any reason, will not be made up or reimbursed, according to PCM policy. Every effort should be made between Faculty and Students to ensure that all 16 lessons of each semester occur within that semester s time frame. (Summer Semester is 10 weeks). ***** Left over lessons will not be rolled over into the next semester.***** Waiting Area Policy Please do not hang out in the halls. Students and parents who are waiting for their lesson to begin or waiting for a family member to finish their lesson, are requested to wait in the waiting area on the second floor in front of the PCM Executive Director s office. Please be quiet and respectful while patiently waiting due to the business being conducted in the offices around the waiting area. Financial Aid Policy PCM has a limited amount of funds available for Financial Aid, and it is given only to those students who submit a completed application form and whose family income falls within the current income limits. Financial Aid, if granted, can only be applied toward 16 private lessons with one instrument, per semester. Return Check Policy Portland Conservatory of Music charges a fee of $25.00 on every returned check. Page 5 of 6 School Cancellation Policy If the school closes due to inclement weather, announcements will posted on WCSH Channel 6, Storm Team 13, WPOR, PCM s website at and on the PCM answering service at Use of PCM Studios Students are allowed to use PCM studios for rehearsing and practicing, by reservation only, when the studios are not being used for lessons and/or classes. If you wish to use a studio, you must reserve the day and time, through the PCM office, prior to the day you wish to use it. These arrangements can be made by calling or ing the PCM office. All students under the age of 18, must be accompanied by a parent or guardian.

6 Page 6 of 6 PCM School Calendar August 26 - September 8, 2013 September 9, Monday November 27, Wednesday-December 1, Sunday December 2, Monday December 23, Monday - January 5, 2014, Sunday January 6, 2014, Monday January 6 - January 17 January 12, Monday January January 20 January 21, Tuesday February 17-23, Monday-Sunday April 21-27, Monday-Sunday May 25, Sunday May 26 June 8, Monday-Sunday June 9, Monday August 17, Sunday August 18-24, Monday-Sunday August 25-September 7 FALL REGISTRATION Fall Semester begins Thanksgiving Break, School Closed (no lessons, rehearsals, etc.) School resumes 2 wks. Christmas Vacation, School Closed (no lessons, rehearsals, etc.) School resumes SPRING REGISTRATION Fall Semester ends Fall Make-up Week Martin Luther King Day, School Closed (no lessons, rehearsals, etc.) Spring Semester begins February Vacation April Vacation Spring Semester ends 2 wks. Spring Make-up & Summer Registration Summer Semester begins Summer Semester ends Summer Make-up week Summer Vacation, School Closed

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