CAP Saturday Music Classes Application

READ CAREFULLY: This is a commitment that requires SATURDAY attendance. Consider this carefully BEFORE applying. Student’s and parent’s digital signatures below, and the submission of this application, confirm that BOTH student and parent have read and understand this.

Student's Digital Signature*
First Last

Parent's or Guardian's Digital Signature*
First Last

How or from whom did you learn about the Community Arts Program (CAP)?*

Student's First Name*

Student's Last Name*

Student's Date of Birth (mm/dd/yyyy)*
Month
Day
Year

Parent's or Guardian's First Name*

Parent's or Guardian's Last Name*

Relation to Student (e.g., father, mother, grandparent, etc.)*

Student's Primary Home Address*
Street Address Address Line 2 City State ZIP Code

Home Telephone*

Parent's or Guardian's Cell

Parent's or Guardian's Email*
Enter Email Confirm Email

Student's Cell

Student's Email*
Enter Email Confirm Email

Student's School*

Grade in 2023-24 School Year*

Student's School Address*
Street Address Address Line 2 City State ZIP Code

Is the student enrolled in a Miami-Dade County Public School (M-DCPS)?*
Yes
No

Enter below the student's M-DCPS ID #.*

School Music Teacher

School Music Teacher's Phone

School Music Teacher's Email
Enter Email Confirm Email

Is the student enrolled in Breakthrough Miami on Saturdays?*
Yes
No

Indicate your Saturday Breakthrough Miami HOURS.*

Also, indicate your Saturday Breakthrough Miami LOCATION.*

List ANY other 9:30 a.m.-4:30 p.m. Saturday activities and times in which the student is/may be involved. NOTE: This may limit our ability to provide any or the best schedule for the student's CAP classes.*

Does the student receive free lunch at school?*
Yes (Proof of Waiver is required.)
No

Parent or Guardian: UPLOAD BELOW the Proof of Waiver showing that the student receives free lunch at school. ALL INFO REMAINS CONFIDENTIAL.*
Max. file size: 300 MB.

Does the student have any disability of which we should be aware in order to best serve the student? ALL INFO REMAINS CONFIDENTIAL.*
Yes
No

Please describe the disability below.*

CAP Saturday Music Classes is $50 each week. Each week includes one 55-minute instrument lesson and music theory. Is the student in need of a weekly scholarship?*
Yes (If yes, EACH parent or guardian is required to submit the most-recent Tax Form 1040 and two most-recent pay stubs.)
No

What amount, $0-$50, can the parent(s) or guardian(s) pay each week?*

Parents or Guardians: ALL of the following items MUST be uploaded below for scholarship consideration: (1) Most-recent Tax Form 1040 from EACH Parent or Guardian (unless filed jointly); (2) Two most-recently-dated pay stubs from EACH parent or guardian. ALL INFO REMAINS CONFIDENTIAL.*
Max. file size: 300 MB.

File
Max. file size: 300 MB.

IN THE BOX BELOW, briefly outline your need and provide helpful comments that support your need. All information is strictly confidential.

Please use this area to indicate any additional info. for scholarship consideration.*

Select the one instrument that the student would like to study:*
Violin
Viola
Cello
Upright Bass
Guitar
Piano
Saxophone
Flute
Trumpet
Drums
Voice
Other

If the one instrument the student would like to study is not on the above list, please enter that instrument below.*

Does the student have daily access to their choice instrument for consistent, daily practice at home? (If piano, this refers to an actual piano, not a "keyboard.")*
Yes
No

Will the student receive ANY instruction on their choice instrument from elsewhere other than CAP?*
Yes
No

Where else will the student receive ANY instruction on their choice instrument?

How long (i.e., years, weeks, or months) has the student had lessons on their choice instrument? (If new to the instrument, enter "0".)*

With whom has the student studied their choice instrument? (If new to the instrument, enter "N/A".)*

List all music classes and lessons that the student has had and for how long.*

Write up to five lines that tell why the student would like to participate in this program, and what the student would like to do with music*

PARENTS' NOTE: Students' success hinges on parents' encouragement and interest in their child's learning and personal growth. A commitment to consistent Saturday attendance is key to this.

Additional field trips (i.e. concerts and performances) will be a part of this program. Continuation in the music program is based on consistent, weekly attendance, behavior, and satisfactory growth within the program.

I give permission to use my child's name, photograph and/or performance recordings (including audio and/or video forms) in brochure, web, and other promotional materials.

Parent's or Guardian's Digital Signature*
First Last

Date*
MM slash DD slash YYYY

Your Order