QCMLP Sign-Up - Manchester Community Music School

QCMLP Sign-up Application

The Queen City Music and Leadership Program (QCMLP) is designed to connect students with accomplished musician-educators in private lessons, ensembles, and classes for their musical and holistic development. The program is open to students in grades 6-12 in the greater Manchester area and meets Tuesday and Thursday 4:00-6:30pm. For more information, contact: Executive Director, Polly Towner at polly@mcmusicschool.org

Company

This field is for validation purposes and should be left unchanged.

Student Information

Full Name:(Required)

Date of Birth:(Required)

Pronouns:(Required)

Other Pronouns:(Required)

Student Address(Required)

City:(Required)

State:(Required)

Zip/Postal Code:(Required)

School/Grade:(Required)

Phone Number:

Email Address:

Ethnicity:

*This information is optional but is helpful in securing much needed funding for the school. All information is confidential and only reported in number.

Guardian Information

Guardian Full Name:(Required)

Guardian Address (if different from student):

City:(Required)

State:(Required)

Zip/Postal Code:(Required)

Preferred Contact Method:(Required)

Other Contact Method:(Required)

Guardian Phone Number(Required)

Guardian Email Address(Required)

Emergency Contact Information

Full Name & Relationship to Student(Required)

Phone #1(Required)

Phone #2

Lesson Information

1st Choice Instrument:(Required)

2nd Choice Instrument:(Required)

How Would You Rate Your Skill Level?(Required)

I am a beginner

I already play an instrument, and have for years

I will need an Instrument

How many years?(Required)

About You:

Please write a short personal statement outlining why this program interests you, your goals for participating in QCMLP, and your relationship to music.(Required)

Please include one letter of recommendation from a teacher, mentor, or trusted adult. *EXCLUDING PARENT*(Required)

Tuition Information:

Photo Waiver

Photo Waiver(Required)

The Manchester Community Music School shares photos, videos, and audio of our students in printed materials, on our website, and on social media to share our mission and encourage more people to become a part of our community.

I give permission for my child’s photo, video, or audio to be used by MCMS

I do not give permission for my child’s photo, video, or audio to be used by MCMS

Digital Signature

Guardian Signature:(Required)

Student Signature:(Required)