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Financial Aid Request for Elementary Band and Strings SPRING 2021
You must complete this Financial Aid Request Form for Spring Band & Strings. DO NOT REGISTER FOR THE BAND AND STRINGS CLASS. THIS FORM WILL HANDLE YOUR REGISTRATION. AFTER YOU COMPLETE AND SUBMIT THIS FORM, YOU WILL NEED TO CALL THE HILLCREST CENTER FOR THE ARTS AT 805-381-2747 TO FINALIZE THE REGISTRATION PROCESS.
PLEASE COMPLETE A SEPARATE REQUEST FOR EACH STUDENT. There is a link for additional requests at the end of this form.
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Email
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Your email
Parent First Name
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Your answer
Parent Last Name
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Your answer
Student First Name
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Your answer
Student Last Name
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Your answer
Student Birth Date
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MM
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DD
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YYYY
Street Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Parent Email
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Your answer
Best Phone
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Other Contact Information
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Elementary School
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Your answer
Please list the reason for your request for financial assistance
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Grade in School
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Check Off Band or String Program Selected
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Acacia Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Acacia Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/29/21
Acacia Advanced Band with Janine Delwarte. T/Th 1/5/21-4/1/21
Acacia Beginning Strings with Laura Asenas. M/W 1/4/21-3/29/21
Acacia Advanced Strings with Laura Asenas. M/W 1/4/21-3/29/21
Aspen Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Aspen Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/31/21
Aspen Advanced Band with Janine Delwarte. T/Th 1/5/21-4/1/21
Aspen Advanced Strings with Jordan Anne Martone. T/Th 1/26/21-4/29/21
Banyan Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Banyan Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/31/21
Banyan Advanced Band with Michelle Hagen. M/W 1/4/21-3/31/21
Banyan Advanced Strings with Jordan Ann Martone. T/Th 1/26/21-4/29/21
Conejo Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Conejo Beginning Percussion with Michelle Hagen. T/Th 1/5/21-4/1/21
Conejo Advanced Band with Janine Delwarte. T/Th 1/5/21-4/1/21
Cypress Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Cypress Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/31/21
Cypress Advanced Band with Michelle Hagen. M/W 1/4/21-3/29/21
Cypress Advanced Strings with Jordan Ann Martone. T/Th 1/26/21-4/29/21
EARTHs Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
EARTHs Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/31/21
EARTHs Advanced Band with Michelle Hagen. M/W 1/4/21-4/1/21
EARTHS Advanced Strings with Jordan Ann Martone. T/Th 1/26/21-4/29/21
Glenwood Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Glenwood Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/31/21
Glenwood Advanced Band with Janine Delwarte. T/Th 1/5/21-4/1/21
Ladera Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Ladera Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/31/21
Ladera Advanced Band with Michelle Hagen. T/TH 1/5/21-3/31/21
Ladera Beginning Strings with Laura Asenas. M/W 1/4/21-3/29/21
Ladera Advanced Strings with Laura Asenas. M/W 1/4/21-3/29/21
Lang Ranch Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Lang Ranch Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/31/21
Lang Ranch Advanced Band with Janine Delwarte T/Th 1/5/21-4/1/21
Madrona Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Madrona Beginning Percussion with Michelle Hagen. T/Th 1/5/21-3/31/21
Madrona Advanced Band with Janine DelwarteT/Th 1/5/21-4/1/21
Madrona Advanced Strings with Kimberly Kilgore. T/Th 1/7/21-4/1/21
Sycamore Canyon Beginning Band with Daniel Palomino M/W
Sycamore Canyon Intermediate Band with Daniel Palomino M/W 1/4/21-3/29/21
Sycamore Canyon Intermediate Strings with Daniel Palomino. T/Th 1/5/21-4/1/21
Walnut Beginning Band with Janine Delwarte. M/W 1/4/21-3/29/21
Walnut Beginning Percussion with Michelle Hagen. T/Th 1/5/21-4/1/21
Walnut Advanced Band with Michelle Hagen. M/W 1/4/21-3/31/21
Walnut Advanced Strings with Jordan Ann Martone. T/Th 1/26/21-4/29/21
Weathersfield Beginning Band with Janine Delwarte. M/W 1/4/21/3/29/21
Weathersfield Beginning Percussion with Michelle Hagen. T/Th 1/5/21-4/1/21
Weathersfield Advanced Band with Janine Delwarte T/Th 1/5/21-3/31/21
Weathersfield Advanced Strings with Jordan Anne Martone. T/Th 1/26/21-4/29/21
Westlake Beginning Band with Janine Delwarte. M/W 1/4/21-4/1/21
Westlake Beginning Percussion with Michelle Hagen. T/Th 1/5/21-4/1/21
Westlake Advanced Band with Janine Delwarte M/W 1/4/21-4/1/21
Westlake Advanced Strings with Jordan Anne Martone. T/Th 1/26/21-4/29/21
Westlake Hills Beginning Band with Janine Delwarte. M/W 1/4/21-4/1/21
Westlake Hills Beginning Percussion with Michelle Hagen. T/Th 1/5/21-4/1/21
Westlake Hills Advanced Band with Janine Delwarte T/Th 1/5/21-4/1/21
Westlake Hills Beginning Strings with Laura Asenas. M/W 1/4/21-3/29/21
Westlake Hills Advanced Strings with Laura Asenas. M/W 1/4/21-3/29/21
Wildwood Beginning Band with Janine Delwarte. M/W 1/4/21-4/1/21
Wildwood Beginning Percussion with Michelle Hagen. T/Th 1/5/21-4/1/21
Wildwood Advanced Band with Michelle Hagen. M/W 1/4/21-4/1/21
Wildwood Advanced Strings with Jordan Ann Martone. T/Th 1/26/21-4/29/21
What instrument will your student play?
Your answer
How Much Tuition Can You Pay? Tuition for the Spring Zoom Session of Elementary Band and Strings is $185.00. While we can provide up to 100% Tuition Assistance, the Financial Aid Pool can serve more students if each parent pays an amount that they afford. Our suggested minimum payment is $46.25.
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Your answer
Do You Need to Make Payments?
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YES
NO
If you need to make payments the payment schedule is 25% of the total due on 1/2/21, 2/1/21, 3/1/21, and 4/1/21. Payments can be made in several ways. Please select your payment method:
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Credit Card – You Must Call 805-381-2747 to make the 1st payment and the remaining 3 payments will be automatically deduced from your Credit Card.
Check payable to ACCV and mailed to ACCV Chorus, 403 W Hillcrest Drive, Thousand Oaks, CA 91360
Money Order payable to ACCV and mailed to ACCV Chorus, 403 W Hillcrest Drive, Thousand Oaks, CA 91360. You may deduct the cost of the money order from your payment.
Checks or Money Order can also be dropped off into the CRPD Mailbox Located outside to the left of the Main Administration Doors at 403 W Hillcrest Drive, Thousand Oaks, CA 91360. Please place the Check or Money Order in an envelope Addressed: Attn: ACCV Chorus. Please call to let us know your are dropping this off.
By Clicking the Yes below, I agree to make scheduled payments or have my Credit Card Charged an automatic payment equal to 25% of the total agreement amount charged on 1/2/21, 2/1/21, 3/1/21, and 4/1/21.
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YES
By clicking Yes below I agree to the following AGREEMENT, WAIVER, AND RELEASE. In consideration for being permitted by the Arts Council of the Conejo Valley and its cooperating agencies (the Conejo Recreation & Park District, the Conejo Valley Unified School District, Meadows Arts and Technology School [MATES], and the Conejo Schools Foundation) to participate in the Elementary Music Activities or the Young Artists Ensemble Youth Theater Program, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activities. This release is intended to discharge in advance the Arts Council of the Conejo Valley and its cooperating agencies (the Conejo Recreation & Park District, the Conejo Valley Unified School District, Meadows Arts and Technology School [MATES], and the Conejo Schools Foundation) (their officers, employees, and agents) from any and all liability arising out of or connected in any way with my participation in said activities, even though that liability may arise out of negligence or carelessness on the part of the persons or entitles mentioned above. It is understood that these activities involve an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold the above person or entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activities.
Additionally, I fully understand that my participation in the above-referenced activities exposes me to the risk of personal injury, death, communicable diseases, illnesses, viruses, and/or property damage. I hereby acknowledge that I am voluntarily participating in this activity and agree to assume any such risks.
VIRTUAL CLASS RELEASE: I hereby warrant and agree, that the conditions of my environment are safe, free from obstructions, and are suitable for participation in the above-referenced activity. I further understand and agree that any material downloaded, viewed or otherwise obtained through my participation in said activity is done at my own risk and the Arts Council of the Conejo Valley and its cooperating agencies (the Conejo Recreation & Park District, the Conejo Valley Unified School District, Meadows Arts and Technology School [MATES], and the Conejo Schools Foundation) is not responsible for any loss, alteration, corruption or other damage to my personal property, including computers, networks and other property used as part of my participation.
PARENTAL CONSENT: I hereby consent that those listed as registered participate in the above activities, and I hereby execute the above Agreement, Waiver, and Release on his/her/their behalf. I state that said minors are physically able to participate in said activities. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or any injury or property damage that said minors may sustain while participating in said activities. I UNDERSTAND THAT IMPORTANT INFORMATION is available regarding 1) concussions that may occur during physical activities, and 2) information regarding the use of opioids, and acknowledge receipt of the information from our partner agency, the Conejo Recreation & Park District via
www.crpd.org/concussion
and
www.crpd.org/opioid
.
CONSENT FOR EMERGENCY MEDICAL TREATMENT: As the participant or the parent, legal guardian, or appointed conservator of the participant of this program, I hereby give consent to the Arts Council of the Conejo Valley to obtain all medical or dental care for myself or my dependent as prescribed by a duly licensed medical professional. This care may be given for whatever conditions are necessary to preserve the life, limb, and well-being of myself or my dependent.
I UNDERSTAND THAT THE ARTS COUNCIL OF THE CONEJO VALLEY REQUIRES THAT USES THE CONEJO RECREATION AND PARK DISTRICT CODE OF CONDUCT (
www.crpd.org/conduct
) AND YOU AGREE TO ABIDE BY ITS POLICIES AND CONDITIONS. I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE ARTS COUNCIL OF THE CONEJO VALLEY AND ITS COOPERATING AGENCIES (THE CONEJO RECREATION & PARK DISTRICT, THE CONEJO VALLEY UNIFIED SCHOOL DISTRICT, MEADOWS ARTS AND TECHNOLOGY SCHOOL [MATES], AND THE CONEJO SCHOOLS FOUNDATION) AND I AGREE TO IT OF MY FREE WILL. PLEASE NOTE: Arts Council of the Conejo Valley often takes photos of participants during classes and special programs, as well as other activities both schedule and unscheduled. These photos may be used for publicity purposes on the ACCV’s and CRPD’s printed materials as well as online at
www.HillcrestArts.com
,
www.YAEonline.com
, and
www.CRPD.org
and on other ACCV and Hillcrest Center for the Arts related Facebook or other social media.
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