Soundscapes Registration
Eligibility
Carver:
Students at Carver Elementary School in 1st, 2nd, 3rd, and 4th grade are eligible to enroll at Carver.

Greenwood:
Registration information is due by November 1, 2019 for new applicants. Accepted level 1 students begin on January 13, 2020.

Soundscapes will notify you if your child has been accepted via lottery into the program, or if your child is placed on the waiting list.

Take a virtual program tour ---> http://soundscapes.org/about/program-tour
Learn more about Soundscapes' program ---> http://soundscapes.org/program
School *
Student Information
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Gender *
School Teacher Name (write N/A if unknown) *
Your answer
Classroom # *
Your answer
Lunch Number (Student ID #) *
Your answer
Grade *
Does your child have an Individual Education Program (IEP)? *
Does your child have any allergies (food/other), health problems, or religious observances that we should know about?
Your answer
Family Information
Home Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Phone Number *
Your answer
Are parent or guardian employed by any of the following organizations? *
Does your child have a sibling currently enrolled in Soundscapes? *
Required
If a sibling is currently enrolled in Soundscapes, what is their first and last name? *
Your answer
Financial Information
In order for Soundscapes to make this after school program accessible, we must collect some basic financial information about your family. This personal information will be kept confidential and will not be shared outside the organization on an individual basis. This information is required for enrollment in Soundscapes.
Total Household Family Size (Including adults) *
Select the number closest to your family's total annual household income from all sources *
Transportation
Bus stop MAY be different than the student's regular stop. Please note: If you would like to use a daycare stop, a daycare request form must be filled out in the Main office THIS current school year. All bus stops must be within the site's bus zone.
Transportation: This year, my child will: *
Primary Contact Information
Your contact information is used to contact you about Soundscapes program related information only. This information will remain confidential.
Parent/Guardian #1 Full Name: *
Your answer
(PG1) Work Phone Number:
Your answer
(PG1) Home address (if different from child's address):
Your answer
(PG1) Mobile Phone Number: *
Your answer
(PG1) E-mail address: *
Your answer
Parent/Guardian #2 full name:
Your answer
(PG2) Work Phone Number:
Your answer
(PG2) Home Address (if different from child's address):
Your answer
(PG2) Mobile Phone Number:
Your answer
(PG2) Email:
Your answer
(PG2) Email:
Your answer
Emergancy Contact Information
Persons authorized to pick up child (other than parent) OR to contact in case of emergency. These contacts must be different than those listed above, and there must be at least one name.
EC-1 Full Name: *
Your answer
EC-1 Relationship to child: *
Your answer
EC-1 Phone Number: *
Your answer
EC-2 Full Name:
Your answer
EC-2 Relationship to child:
Your answer
EC-2 Phone Number:
Your answer
EC-3 Full Name:
Your answer
EC-3 Relationship to child:
Your answer
EC-3 Phone Number:
Your answer
Photo and Video Release
By participating in Soundscapes, I give permission and consent for the above named child to be photographed, interviewed, or video recorded during program activities. I further give permission and consent that any such media may be published via any media medium (i.e. print, broadcast, internet or any other available medium) and used by Soundscapes and its agents, to illustrate and promote the program experience.
Photo/Video Release Initials *
Your answer
School Records Release
By participating in Soundscapes, I authorize the release of records for the above named child to Soundscapes. These records may include, but are not limited to, student educational records, IEP (if applicable), eligibility minutes, psychological reports, sociological history reports, educational reports and medical/health records.
School Records Release Initials *
Your answer
Digital Signature
By writing your full name (first and last name) you agree to the above-mentioned terms and conditions, and verify that all of the information provided is accurate to the best of your knowledge.
Digital Signature: Type First and Last Name *
Your answer
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