Accent Pontiac 2023-2024 Elementary School Enrollment Form

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Accent Pontiac is a social change through music program in Pontiac, Michigan. A partner of the Pontiac Schools, we offer during and after-school instrumental music classes through a mission to strengthen Pontiac's youth and community through equitable access to intensive and consistent music making. Learn more at www.accentpontiac.org

This enrollment form is for Accent Pontiac (AP) in-person programming for the 2023-2024 school year! Students will have their AP music classes and a snack at Pontiac Middle School (1275 Perry St, Pontiac, MI 48340) Tuesday-Thursday After School-6:00pm. All students will have percussion classes, brass or woodwind classes, as well as chamber and ensemble classes working with each other in groups.

Enrolled AP students will be released from school at the end of the day, and be shuttled to the Pontiac Middle School cafeteria to start programming with a meal! We understand that transportation is sometimes a challenge, which is why we will be able to drive ~25 students to the middle school, and we have very limited assistance with transportation home on a NEED basis. If you are able to pick up your musician from programming, we strongly encourage you to do so! Pick-ups will take place in the middle school cafeteria entrance at Pontiac Middle School 1275 Perry St, Pontiac, MI 48340. If your musician does not attend a partnering Pontiac School (Alcott, Walt Whitman, Herrington, ILA, ITA), but would still like to enroll in AP, please contact Operations Director, Courtney Marshall-Ross to discuss details.

Accent Pontiac has the ability to help with transportation home. If your child would like to participate in this music program, but you do not have reliable transportation to get them home, please select that option below and an Accent Pontiac staff member will contact you to see if we can support you and your child on a case-by-case basis.

If you have any questions, please call or text Ms. Courtney at 810-214-3474.

Student Name *

Student Age *

Student Grade *

Student Birthday *

YYYY

Student Phone Number (if applicable)

Student School *

Student Address *

Student T-shirt size *

Youth S

Youth M

Youth L

Youth XL

Adult M

Adult L

Adult XL

Youth Small

Other:

Required

Parent/Guardian Name *

Parent/Guardian Phone Number *

Parent/Guardian Email
*

Parent/Guardian Relation to student *

Emergency Contact Name (Different than Parent/Guardian above) *

Emergency Contact Phone Number (Different than Parent/Guardian above) *

Emergency Contact Relation to student *

Does this student have any medical issues or food allergies? *

While we will transport students from Walt Whitman and Alcott elementary schools to Pontiac Middle School for after-school programming, we are not able to guarantee transportation home after programming for all students. We are hoping to gather information on the number of student musicians this impacts. Please let us know if your young musician would require a ride home at 6pm on weeknights in order to participate in our music program. This transportation option is currently on a wait list. *

I will pick up my student at Pontiac Middle School every day from Accent Pontiac programming.

I require assistance getting my student to home from the Pontiac Middle School in order for my child to participate in Accent Pontiac.

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