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| Student name: |
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| Grade: |
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| Gender: |
Female
Male |
| Date of Birth: |
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| Current School: |
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| Home street address |
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| City/town: |
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| Province: |
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| Postal code: |
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| Home phone number |
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| Email address |
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Parent/ Guardian Email address
(if different from above) |
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| Any medical Concerns: |
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| Residence Options: |
$595 - Residence Camper
$395 - Day Camper |
| T-shirt size: |
Youth L
Youth Extra L
S
M
L |
| Instrument or Voice Type: |
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| Years of Playing Experience: |
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| Royal Conservatory of Music or Conservatory Canada Level ( if known) |
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| Current Private Music Instructor ( If applicable): |
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| Current Private Music Instructor Email: |
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| Current Private Music Instructor Mail: |
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| Current Band or Choir Director ( If applicable) |
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| Current Band or Choir Director Email: |
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| Current Band or Choir Director Mail: |
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| How did you hear about this program? |
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| Note: |
Please submit an audio recording that includes two contrasting selections, showing your current playing ability. It is preferable that audio files be emailed directly to srunge@mta.ca or posted to YouTube (send the link to srunge@mta.ca). A CD can also be mailed to:
Mount Allison University
Department of Music
134 Main St
Sackville, NB Canada
E4L 1A6 |
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1. Upon receipt of the application and audio recording, the application will be evaluated and a confirmation of application status will be sent be email.
2. Once you are accepted into the program, a $50 deposit is required to secure your place, with the balance of tuition due on July 2, 2013. On-line payment information will be provided in the acceptance email.
3. Please keep a record of the payment for reference.
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| Fees: |
$595 including room and board; $395 for day camp |
| Deadline: |
May 1, 2013. Late registrations may be accepted, spacing permitting. |
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| Authorization: |
I acknowledge all information
given is accurate to the best of my knowledge. In permitting
my child to attend Mount Allison University summer program,
I, the undersigned, permit my child to participate in
the full range of activities and authorize the Program
Coordinator or his/her appointed, in the event of accident
or illness affecting this above named student, to authorize
on my behalf all procedures, including admission to hospital
and necessary treatment therein, as he or she may deem
necessary for the care and well-being of the student.
I understand that my child is obliged to abide by the
rules and regulations of Mount Allison University and
failure to do so may result in suspension from the program
without any refund.
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Name of parent/guardian (as a sign
of agreement): |
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| Date: |
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