Summer '18 Community Music Program
Date of Application *
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Student Last Name *
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Student First Name *
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Student's Date of Birth *
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Daytime Contact Information
Parent/Guardian Name *
Your answer
Email Address *
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Phone Number *
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Street Address *
Your answer
City, State, Zip *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Emergency Contact Relationship with Student *
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Anyone besides parent or guardian who is allowed to pick up student
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Enrollment Specifics
Please check which session(s) you would like to attend: *
I would like my instrumental class to be: *
Photography Authorization *
I hereby grant to Tufts University, its officers, and employees (collectively referred to herein as “University”) and its agents and assigns the worldwide, perpetual, irrevocable right to: (1) photograph the child/ward of the undersigned; and (2) reproduce, distribute, display, create derivative works of and otherwise use the name, photograph and likeness of the child/ward of the undersigned, and any such recordings for and in connection with the University’s public relations, publicity, promotional, fundraising and recruitment purposes, for all purposes, by any means, methods and media (print and electronic) now known or in the future developed that the University deems appropriate. I make this grant of rights with the understanding that no compensation will be paid to me by the University for such grant. I understand and agree that all right, title and interest, including copyrights, in the materials created by the University pursuant to this agreement are the exclusive property of the University and that I will obtain no rights in such materials. I also understand that the University is not actually required to use the photograph or likeness of my child/ward in any way.
Payment Information
Applications and $100 deposit are due by April 15th. The tuition balance will be due by June 1st.

Payment may be made with checks, cash, or credit cards.

Master card or Visa may be used for payment in Edith Auner’s office, or you may make payments by credit card on this Tufts secure e-commerce website:
https://secure.touchnet.net/C21525_ustores/web/product_detail.jsp?PRODUCTID=133

Checks should be made out to: Trustees of Tufts College. Please give checks directly to Edith Auner or mail them to:

Edith Auner
Granoff Music Center
Tufts University
20 Talbot Avenue
Medford, MA 02155

In order to apply for financial aid, please submit a copy of your most recent tax return. Thank you!

Payment Selection *
Please tell us which payment options you are choosing:
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Important Reminder!
We will need a copy of your child's immunization record by June 1st.
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