The Walter R. Garrison Arts Leadership Academy: Rhythms for Success

Musicopia Student Registration

* = required

Student Information

Student First Name

Student Last Name:

Birthdate:

School (for the registration year):

Grade (for the registration year):

Student ID #

Instagram Handle

Student Home Phone

Student Mobile Phone

Student Email

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name:

Parent /Guardian Telephone

Parent/Guardian Tel Type

Parent/Guardian Alt Tel

Parent/Guardian Alt Tel Type

Parent/Guardian Email

Parent/Guardian Email Type

Additional Parent/Guardian

Additional Parent/Guardian First Name

Additional/Guardian Parent Last Name:

Additional Parent/Guardian Telephone

Telephone Type

Addtll Parent/Guardian Alternate Tel

Alternate/Guardian Tel Type

Additional Parent/Guardian Email

Addtl Parent/Guardian Email Type

Drumline Specific Questions

What instrument are you the best at playing?

What instrument would you like to learn at practices?

What skills would you like to improve by the end of the school year?

What equipment do you have at home to practice?

11th & 12th graders: Eastern University, Lincoln University, and Widener University are offering BIG SCHOLARSHIP $$ for you to join their drumline and band! Please check the box for each audition you would like to take:

Drummers 14 and older: Are you interested in being paid to attend regional and after-school drumline rehearsals?

Yes

What is your t-shirt size (in Men's sizes)?

Survey Questions

My Artistry (Musical Ability)

	Strongly Agree	Agree	Somewhat Agree	Disagree	Strongly Disagree
I listen to and play music by many different artists.
Most weeks, I play or practice my instrument 3 or more days a week.
I read music confidently.

My Feelings

	Strongly Agree	Agree	Somewhat Agree	Disagree	Strongly Disagree
Music will always be an important part of my life.
I feel confident playing my instrument in an ensemble (with other people).

Narrative Questions

Short Answer, please write as much as you’d like for the following prompt:

What you are most nervous about in starting this program?

Contact Information