NAU requires a parking permit for all vehicles in lot P13b (the parking lot just outside of our Academy). The Academy has arranged permits available for Academy parents/families/students that do not include NAU employees or students, which allows parking in all NAU lots marked as “NC” (North Commuter).

Please see the Parking Information flyer for more information on parking pass options. If you do not have this flyer, please email Academy@nau.edu for an updated copy.

ATTENTION: PARKING INFORMATION

EMAIL ADDRESSALTERNATIVE PHONE NUMBERPHONE NUMBER

RELATION TO STUDENTPARENT/GUARDIAN NAME(S) (if applicable)

CITY/STATE/ZIPMAILING ADDRESS

SCHOOL ATTENDING (if applicable)DATE OF BIRTHFEMALEMALE

If you are a returning student and your contact information has not changed, please skip to Academy Policies on p. 2

NOYESRETURNING STUDENT?

STUDENT FIRST NAMESTUDENT LAST NAME

Registration is not complete and instruction is prohibited until at least 25% of full-year tuition, or 50% of semester tuition, is paid, and a completed registration form has been received in the Academy Office.

Payment and registration are due prior to the start of the student’s first scheduled class.

Fall 2021/ Spring 2022 Youth Music Registration

DATEREGISTRANT SIGNATURE (if student is 18 years or older)PARENT/GUARDIAN SIGNATURE (if student is under 18 years old)

One free make-up lesson is allowed each semester for a single music lesson that is cancelled or missed for any reason. Subsequent lessons cancelled with less than 24 hours prior or skipped entirely will be considered forfeited and will not be rescheduled. Rescheduling of a scheduled music lesson may occur once per calendar month. If further lessons must be cancelled beyond this allowance, those lessons will be considered forfeited.No audio-video equipment or cameras are allowed inside an NAU Auditoria. NAUSOM retains all rights to images and all audio-visual recordings of Academy activities. No one purchasing the videos/photographs can post them on social media, including their own Facebook pages (with the exception of the NAUSOM and FSO using said videos and photos for promotional purposes.)

Music Policy

25% of a full-year registration, or 50% of a semester registration, is due before a student may start classes. Fall Registration is due by Friday, 09/10/2021. The remaining payments will be due on 10/22/2021, 01/14/2022, and 03/25/2022. Students who have not paid their full semester dues will not be able to participate in the end-of-semester productions. Late enrollments will not be given an alternative payment schedule.A $25 late fee will apply to outstanding balances after each payment deadline. A $30 fee will apply to any check returned by your bank.Parent/guardian is ultimately responsible for all tuition fees, regardless of any anticipated scholarship awards or outside assistance.Prices listed are for class and instruction only. Prices DO NOT include any additional costs incurred for exams, music, apparel, shoes, etc. If a participant decides to cancel for any reason, funds may be transferred to other current semester activities only. Semester fees will NOT be credited toward the next semester activities. Refunds will not be granted for missed classes. Refund requests must be submitted in writing and are at the discretion of the Program Coordinator.Classes not meeting the minimum enrollment may be cancelled—this will be determined on the Thursday prior to the beginning of the class. If this should occur, all fees will be refunded.Classes may be added at any time as available; classes will not be prorated within the week.Northern Arizona University and/or the Academy are not responsible for lost, stolen, or damaged personal property.All persons on University property must abide by University fire, safety, and legal policies. This includes the NAU Student Cody of Conduct.The Academy will not be held responsible or liable if an Academy student leaves the instruction or facility without a parent/guardian.It is against State of Arizona statutes and NAU policy for anyone not registered through NAU or the Academy to use University property or space for the purpose of lessons, classes, or instruction of any kind. Parent/legal guardian gives consent for student to participate in radio, television, audio and video recordings, and to be photographed, without compensation, for use in Community Music and Dance Academy website, publications, and other promotional materials. Minors will not be identified by name.Please make checks payable to “NAU Academy”. We also accept Discover, American Express, VISA, and MasterCard. We no longer accept cash.

1.

2.

3.

4.

5.

6.

7.

8.9.10.

11.

12.

13.

14.

1.

2.

3.

General Policy

Signature acknowledges acceptance/understanding of the policies listed below:NAU Community Music and Dance Academy - Academy Policies

Academy Music

Requested Teacher (if any):

INTERN PROFESSIONAL MASTER12 Lessons 24 Lessons 12 Lessons 24 Lessons 12 Lessons 24 Lessons

30 minutes $300 $600 $378 $756 $468 $936

45 minutes $450 $900 $567 $1134 $702 $1404

60 minutes $600 $1200 $756 $1512 $936 $1872

• Individual Music Lessons will be available in packages of twelve (12) or twenty-four (24).• Packages of twelve (12) are meant for semester enrollment*• Packages of twenty-four (24) are meant for full year enrollment*• All balances must be paid before purchasing additional lessons.

Please check the box to indicate your preferred enrollment level and time length. Enrollment is based on teacher avaiability.

Includes individual lessons, group classes, recitals, and choice of Music & Movement , Music Mind Games, or Junior Academy String Orchestra.Please see Page 3 for more information on Group Classes.

Private Lesson Start Date: Monday, August 23rd, 2021Private Lesson End Date (Semester): Friday, December 6th, 2021

Private Lesson End Date (Full Year): Friday, May 6th, 2022

PLEASE NOTE:

Intern Teachers: Undergraduate Music Majors at NAUProfessional Teachers: Received their Undergraduate degree in Music and are pursuing a graduate degree in MusicMaster Teachers: Serve as NAU School of Music faculty members, or have obtained an advanced degree in music, or have equivalent professional experience

Violin Viola CelloRequested Instrument:

*If you believe you will need more than twenty-four (24) lessons over the year, please place a request at Academy@nau.edu. Approval of additional lessons will depend upon time availability and instructor consent.

SUZUKI LESSON PACKAGES

We understand that this year has put several families in our community in a tight bind, while still trying to move forward with Music and the Arts for themselves and their children. As such, we are opening up the Adel Scholarship to anyone who would like to apply, and simplifying the application for everyone. The scholarship amount will depend on your level of enrollment, with a minimum scholarship of $50, and a maximum of $400. Students must be enrolled in music lessons to qualify. Students enrolled in semester lessons must re-apply for a Spring scholarship (due by December 10th, 2021). Scholarships awarded will total no more than $400. If you would like to apply for assistence for this academic year, plase check the box below:

If you believe you will need additional assistance, please check the box here:We will reach out to you for more information on how we can help this year.

Each student may apply for this scholarship. Scholarship amounts will be announced by Friday, September 17th. The scholarship will be applied to the remaining balance of the recipient. Students must still register the student in accordence with the Academy Policies (see page 2 for more details).

ADEL SCHOLARSHIP HELP

ADDITIONAL HELP

I would like to apply for the2021/2022 Adel Scholarship

I am interested in additional help for this year

Academy Music (Cont.)

Cello: $15/monthViola: $15/monthViolin: $10/month

New RentalContinuing Rental

Instruments are able to be rented for students enrolled in lessons at the Academy, based on availability. A violin rental costs $10/month. A viola or a cello rental costs $15/month. Inquire with the office about instrument sizes and availability.

Fall Semester: Aug. - Dec. (4.5 months) Spring Semester: Jan. - May (4.5 months) Full Year: Aug. - Mayl (9 months)

INSTRUMENT RENTALS:

GROUP CLASSES

ORCHESTRA

Age by Sept. 1, 2021 Day Time Price SelectToddler Music & Dance 1-3 Tuesday 1:45-2:15pm $100

Music & Movement 3-5 Thursday 4:35-5:05pm $60

Music & Mind Games* 5-10 Thursday See Group Schedule $60

Parent/Beginner Class** 4+ TBD TBD $385

Youth Fiddle 10+ Thursday 6:30-7:30pm $120

Age by Sept. 1, 2021 Day Time Price SelectPrelude Orchestra 10+ Thursday 5:15-6:15pm $120

Junior Academy Orchestra 10+ Thursday 5:15-6:15pm $120

*Music & Mind Games: - Classes are assigned by coordinators based on ages, instruments, and ability**Parent Beginner Class: - Parent instruction: Monday, Aug. 23rd through Wednesday, Aug. 25th, 6:30-8:30 p.m. - Group instruction with child begins Thurs, Sept. 12. Includes Music Mind Games or Music & Movement, re-cital and community performances. - Rental instrument is included based on availability

Group Classes are sold on a Semester basis. Fall Semester: Aug - Dec 2021Please check the box to indicate your preferred enrollment level and time length. Enrollment is based on teacher avaiability.

Orchestra enrollments are sold on a Semester basis. Fall Semester: Aug - Dec 2021Please check the box to indicate your preferred enrollment level and time length. Enrollment is based on teacher avaiability.

Requested Teacher (if any):

Please check the box to indicate your preferred enrollment level and time length. Enrollment is based on teacher avaiability. We offer private instruction for a wide variety of instruments and voice.

INTERN PROFESSIONAL MASTER12 Lessons 24 Lessons 12 Lessons 24 Lessons 12 Lessons 24 Lessons

30 minutes $282 $564 $360 $720 $450 $900

45 minutes $423 $846 $540 $1080 $675 $1350

60 minutes $564 $1128 $720 $1440 $900 $1800

Intern Teachers: Undergraduate Music Majors at NAUProfessional Teachers: Received their Undergraduate degree in Music and are pursuing a graduate degree in MusicMaster Teachers: Serve as NAU School of Music faculty members, or have obtained an advanced degree in music, or have equivalent professional experience

Violin PianoViola VoiceCello Other:Requested Instrument:

TRADITIONAL LESSON PACKAGES

ARIZONA BOARD OF REGENTS FOR AND ON BEHALF OF

NORTHERN ARIZONA UNIVERSITY Contracts, Purchasing and Risk Management

ASSUMPTION OF RISK, WAIVER, RELEASE, AND CONSENT

FOR NON-STUDENT MINOR PARTICIPATION

(“PROGRAM”)

928-523-4557

RETURN TO: NAU-Insurance@nau.edu PO Box 4067 Flagstaff, AZ 86011 Revised 05/28/2020

Program Information THIS DOCUMENT HAS LEGAL CONSEQUENCES. IT MUST BE COMPLETED AND SIGNED PRIOR TO PARTICIPATION. PLEASE READ IT CAREFULLY BEFORE SIGNING. Program Description and Dates: Department Contact (name, e-mail, phone): Program Location:

Specific Potential Risks to Participants:

Minor’s Information Minor’s Name: Age:

Parent(s)/Legal Guardian(s):

Address:

City: State: Zip:

Phone: Cell: Work:

Emergency Contact: Relationship:

Phone:

Emergency Contact: Relationship:

Phone:

Authorized Pick Up Minor will be picked up at the end of the Program or for any authorized time spent off of campus by: Name: Relationship:

Phone number(s):

Identification will be required to be shown to Program staff by the person who is picking up the Non-Student Minor. If the parent(s)/legal guardian(s) listed above is not the person picking up the Non-Student Minor, add name(s), relationship(s), and phone number(s) of other authorized individuals below.

IN ADDITION TO THE PARENT(S)/LEGAL GUARDIAN(S) LISTED ABOVE, THE FOLLOWING INDIVIDUALS ARE AUTHORIZED TO PICK UP NON-STUDENT MINOR:

Name: Relationship: Phone Number:

Parent/Guardian Agreement

I affirm that I am the adult parent or legal guardian of , a Non-Student Minor under the age of eighteen (18), and I consent to their participation in this Program. In consideration of allowing Non-Student Minor to participate in this Program and related activities, I, on behalf of Non-Student Minor and for myself and my spouse, if any, and our heirs, successors, and assigns:

1. Acknowledge and understand that allowing Non-Student Minor to participate in the Program may involve a variety ofactivities. Such participation, particularly in field trips, “wilderness trips,” sports camps, and physical education, may involverisks, including but not limited to, serious personal injury, partial or permanent disability, sickness, disease or illness, propertydamage, and/or death. These risks may result from Non-Student Minor’s own actions or inactions, from the actions or inactionsof others, or may be inherent to participating in the Program. I understand that I am responsible for ensuring that Non-StudentMinor is properly prepared for all Program activities, and I represent that Non-Student Minor is in good health and is able toparticipate fully in all Program activities. If the Program is an on-line activity, risks include but are not limited to, data mining,phishing, viruses, malware, data breach of on-line information, cyberbullying, exploitation, cyber stalking, on-line grooming,cyber predators, and image replication. Knowing these risks may occur in an on-line Program, I choose to have Non-StudentMinor participate in the Program. I also understand that Northern Arizona University is not an agent of and has noresponsibility for any third party that may provide any services during the Program, including but not limited to, food, lodging,travel, and equipment associated with the Program. I acknowledge that Northern Arizona University has taken enhanced healthand safety measures, in accordance with guidelines from the U.S. Centers for Disease Control and Prevention, in response tothe COVID-19 pandemic. An inherent risk of exposure to COVID-19 exists in any public place where people are present.COVID-19 is an extremely contagious disease that can lead to severe illness and death. By allowing Non-Student Minor toattend the Program at Northern Arizona University, I voluntarily assume all risks related to Non-Student Minor’s exposure toCOVID-19.2. Assume all of the foregoing risks and accept personal and financial responsibility for all damages for personal injury, partialor permanent disability, property damage, or death of Non-Student Minor, or caused by Non-Student Minor, to the fullestextent allowed by law.3. Agree not to sue the State of Arizona, the Arizona Board of Regents, Northern Arizona University, their officers, employees,agents, and assigns, and waive all claims, demands, losses, or damages on account of personal injury, partial or permanentdisability, property damage, or death, caused or alleged to be caused in whole or in part by the actions of any person or entity,to the fullest extent allowed by law.4. Grant to Northern Arizona University and to its employees, agents and assigns the right to photograph Non-Student Minorand use the photo and or other digital reproduction of them or other reproduction of their physical likeness for publicationpurposes for use in connection with Northern Arizona University Programs, whether electronic, print, digital or via the Internet,so long as I have signed the Non-Student Minor Release Form.5. Understand that the only medical treatment that will be provided by the Program is for such things as minor scrapes andbruises. Any medical costs, including emergency medical treatment that may be incurred as a result of Non-Student Minor’sparticipation in the Program will be my financial responsibility. I further understand that medical care facilities may not beimmediately available and I accept the increased risk in the event of injury or death.6. Hereby consent to Northern Arizona University and any appropriate medical facility, and/or to the physician(s) listed below,providing whatever medical services they may deem necessary for Non-Student Minor in the event of an emergency. I certifythat I have adequate insurance and/or other means to pay for any costs and expenses related to these services and I agree to bearsuch costs and expenses in full.7. Agree to review Program rules with Non-Student Minor and agree Non-Student Minor will comply with Northern ArizonaUniversity rules, standards, as well as any specific standards of conduct of the Program that may be provided. I understand thatNon-Student Minor is not permitted to consume alcohol, possess/use weapons or illegal substances, or engage in sexualactivities while participating in the Program. I understand Non-Student Minor may be removed from the Program formisconduct or failure to follow rules or instructions of Northern Arizona University or for any behavior detrimental to orincompatible with the standards of Northern Arizona University or the Program, and I understand that in that event I may notbe entitled to a refund of any or all Program fees and costs.8. Waive and release all claims against the State of Arizona, the Arizona Board of Regents, and Northern Arizona University,their officers, employees, agents, and assigns that arise at a time when Non-Student Minor is not under the direct supervision ofNorthern Arizona University or that are caused by Non-Student Minor’s failure to remain under such supervision or to complywith rules or instructions, to the fullest extent allowed by law.9. Acknowledge and understand that either the Non-Student Minor or Northern Arizona University has the right to decline,decrease, or cease Non-Student Minor’s participation in the event of illness, injury or other medical condition.10. Understand that Northern Arizona University may reduce or stop Non-Student Minor’s participation, in its sole discretion,in the best interest of safety or to aid in the well-being of other participants. Northern Arizona University may require furtherassessment and medical clearance from a physician prior to participation in the Program.

11. ACKNOWLEDGE THAT I HAVE CAREFULLY READ THE ABOVE ASSUMPTION OF RISK, WAIVER, RELEASE, AND CONSENT FOR NON-STUDENT MINOR PARTICIPATION FORM AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY. 12. No oral or written representations can or will alter the contents of this document. I agree that this document shall be governed by the laws of the State of Arizona. Parent/Legal Guardian Signature: Date:

Medical Information Provide a complete and accurate statement of the physical factors that may affect participation in the Program.

Local Physician(s) preferred (if possible): Phone:

Insurance Company (if additional to Program insurance):

Policy: Group Number: Phone: Please indicate any and all special medical conditions Northern Arizona University may need to know about: List any allergies, to include but not limited to, any medications, food, insect bites, and stings, and describe allergic reactions: List any and all medication(s) taken on a regular basis for any reason, to include but not limited to, medication taken for illness(es), allergies, pain and injuries; use additional paper if necessary: List any additional medical/physical information that Northern Arizona University should be aware of, to include but not limited to fitness level, ability to swim, and mobility or sensory limitations: