APPLY NOW 1Applicant2Contact Information3School Information4Instrument Lessons5Activities6Other Information Application Form for New Students - This form is for new students interested in applying to our program. - The application form does not require any payment. - Once the form is received, your child will be added to our waiting list. - We only start new students in the Fall and we contact prospective new students around May-June. - For questions, please Contact Us. Child's Name* First Middle Last Date of Birth* MM slash DD slash YYYY Parents InformationParents Name: Father Mr.Dr.Prof.Rev. Prefix First Middle Last Parents Name: Mother Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Child Resides With*BothMotherFather1st Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 2nd Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Length of Residence in Shreveport/Bossier How long do you expect to remain in the area? Contact InformationEmail 1* Email 2 Home PhoneMothers Cell PhoneFathers Cell PhoneFather's Employer Father's Work Phone Mother's Employer Mother's Work Phone School InformationChild's Current School School for Upcoming Fall Grade for Upcoming Fall*Not in school yetDay carePreschool 3Preschool 4K51st2nd3rd4th5th6th7th8thHigh SchoolDismissal Time Instrument LessonInstrument of Choice*Any Instrument AvailableViolinViolaCelloEarliest you can arrive at Centenary for a private lesson Latest you can arrive at Centenary for a private lesson Desired Entrance Year Month Day Year Remember, we only start new students in the Fall.Which parent will be attending lessons/practices?MotherFatherOther adultAttending Parent's Work Schedule Flexible Work Schedule?*NoneSomeCompletelyPlease describe: Does your child already play a musical instrument?* No. We are looking to start. Yes Current Instrument: Current Instrument Teacher: How long has your child been taking music lessons? What is the current level of playing?For current Suzuki students, tell what Volume and piece they are working on. Other ActivitiesList of child's other activities and days and times of these activitiesOther children in family, ages and activitiesHomework RoutineFamily hobbies and interestsOther Household Routines Other InformationMother's Musical Background (not required)Father's Musical Background (not required)How or from whom did you become interested in the school?Do you have a friend already in the program? If so, who?* Child InterestedYesNoChild Interest ExplanationParent InterestedYesNoParent Interest ExplanationMusical Events Child Has AttendedMusical Enrichment Programs(e.g. Kindermusic, Pre-school choir, Gymboree Music, etc.)Type of Music Played in Home Have you attended a Suzuki Concert or Class? No Yes Have you read "Nurtured by Love"? No Yes Have you read Ability Development For Age Zero? No Yes Have you purchased the Suzuki CD? No Yes Please Select All That Apply: My child has started listening the Suzuki repertoire on a regular basis My child is a pre-schooler, home schooled, can come before 3:00, or can attend CSS Southfield Satelitte Program during the day I agree to practice daily with my child during this first year for 15-20 minutes on a regular basis, 5-6 days per week. My family agrees to stay for the entire recital each time my child plays on one, except in the case of an emergency. Δ
