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New Horizons Summer Registration
Your legal name (must include middle name)
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
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Angola
Anguilla
Antarctica
Antigua and Barbuda
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Australia
Austria
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Bosnia and Herzegovina
Botswana
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Brazil
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Congo, Republic of the
Cook Islands
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Niger
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North Korea
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Panama
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Qatar
Romania
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Rwanda
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Saint Barthélemy
Saint Helena
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Virgin Islands, U.S.
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Country
Gender
*
Male
Female
Other
Date of Birth
*
Month
1
2
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7
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12
Day
1
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20
21
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24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
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1969
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1963
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1952
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1945
1944
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Preferred Phone
*
Email
*
Emergency Contact Name
*
First
Last
Relationship to you
*
Emergency Contact Phone
*
Have you ever attended any divisions or programs at the University of Rochester (including Eastman Community Music School)?
No
Yes
If so, what was your name when enrolled?
If so, what was your student ID number?
Are you an employee of the University of Rochester?
No
Yes
If so,what is your URID number (not your employee ID #)?
Are you a citizen of the US?
Yes
No
If you are not a US citizen, what is your country of citizenship and what type Visa do you have?
Music Information
What instrument do you want to play at this session?
How many years have you been playing this instrument?
At approximately what Suzuki or NYSSMA level do you play?
If you are not sure, please name 1-2 pieces you are currently playing:
If you also play piano, would you be willing to play the piano part of a performance piece?
Yes
No
Pricing and Agreements
Cost - please choose one
*
All rooms include two single beds and a private bath.
I will not be staying on campus - $320 ($225 tuition + $95 food)
I am staying alone in a room - $440 ($225 tuition + $95 meals + $120 room and linens)
I am sharing a room with a musician - $405 ($225 tuition + $95 meals + $85 room and linens)
I am sharing a room with my spouse/friend - $585 ($225 tuition + $190 food + $170 room and linens)
If you are staying in a room with someone, what is their name?
Photography Agreement
Photography Agreement - I hereby consent to be recorded in audio and/or visual formats for the Eastman School of Music. Any such recordings (photographs, video, sound recordings, etc) may be subsequently used without compensation to me by the Eastman School of Music, the University of Rochester, or third partiees for publications (including Web sites), advertising and/or publicity purposes at the discretion of the School's Communications Office. I waive the right to inspect or approve the finished recordings and/or publication use. This release form will be kept on file.
Payment Agreement:
*
I understand that the University must receive the full amount due (as described in this form) before the program start date, and that if full payment is not received by the due date, I may not attend the program. I understand that I am responsible for notifying the Bursar’s Office if my billing information changes at any time, and that payment must be in U.S. dollars.
Name:
*
(your typed name indicates your agreement)
Date
Date Format: MM slash DD slash YYYY
Thank you!
Once we have received and processed your registration, you will receive an invoice from us. Payment must be made by April 15. If you are not able to pay by April 15, please contact Susie Truesdell at 585-857-0243 or struesdell01@gmail.com to make other arrangements.