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 Country

Gender*

Male
Female
Other

Date of Birth*

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)?

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?

If so,what is your URID number (not your employee ID #)?

Are you a citizen of the US?

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

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.

New Horizons Summer Registration

Music Information

Pricing and Agreements

Thank you!

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