SMARTS Student Application Application for quality adult arts classes I. Student Information:Tell us about yourselfName* First Last Birth Date* Age*Gender*MaleFemaleSchool Attending*Current Grade*Any medical conditions SMARTS staff should know for the safety of your child?If none, please type noneII. Parent/Guardian Information:Name* First Last Are you a resident of Youngstown?* Yes No Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Secondary Phone*Email* Required so we can send you class informationE-Signature*By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.III. Authorized Adult for Pick-UpList any names of authorized adults who may pick up your child other than yourselfAuthorized Guardian Pick-Up (other than listed above) First Last RelationshipPhoneIV. Emergency Information:Person to contact in case of emergency OTHER THAN PARENT/GUARDIAN* First Last Relationship*Phone*Secondary PhoneV. Student InterestsPlease select the areas that interest your student.* Drawing Painting Ceramics Photography Acting Theater Set-Design Theater Script Writing Creative Writing Poetry Drums Violin Piano Jazz Rock Band Dance Choir Opera Please order your interest from the selection to the left from MOST to LEAST interested.*Would you take the first class available?*YesNoDo you own or rent a musical instrument? If yes, what instrument?*YesNoInstrumentHave you ever taken any private lessons in the arts?*YesNoVI. Statistical InformationThis is for statistical purposes only.Number of people in householdCombined income level for my household$10,000-$18,000$18,000-$30,000$30,000-$50,000over $50,000Ethnic OriginHispanicNon-HispanicRace (choose ALL that apply)WhiteBlack or African AmericanAsianAmerican Indian or Alaskan Native HawaiianNative Hawaiian or Other Pacific IslanderOtherSMARTS Media ReleaseI, ________________________, the undersigned, hereby allow my child to be photographed and/or recorded by SMARTS, Students Motivated by the Arts for educational and/or promotional purposes, which my include publications, video, website, billboards and advertisements in newspaper and/or television. I also agree that no payment will be made, now or in the future, for my child's appearance or performance.E-SignatureBy signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.Date VII. SMARTS Admissions Policy:SMARTS wants each student to have the most positive, productive classroom experience possible. The following information and rules have been created to help ensure this. Please read over this contract carefully before you sign and your child sign this digital form. Applications for classes are accepted year-round. When classes are available, students will be contacted by mail a few weeks before the class starts. Classes are filled on a first-come, first-serve basis. A waiting list is created if a class is filled. Students are contacted in order from the waiting list if a spot in the class becomes available. The next time classes are offered, students on the waiting list are given first priority. Students without applications on file may not take classes at SMARTS until an application is completed. If for some reason you know that your student cannot attend one of his/her scheduled classes, you must call 330-313-3031 to notify SMARTS of an approved absence. Students who miss more than three classeswithout notifying SMARTS will be asked to withdraw from this session of SMARTS classes, giving another student the opportunity to participate. SMARTS students are expected to arrive on time for their classes. Students who are more than 15 minutes late to class will not be allowed to participate that day. Students are expected to attend the entire class. Parents/guardians are responsible for signing out SMARTS students when they are picked up. Students must be picked up on time. If other arrangements are necessary, they must be worked out with SMARTS staff. Cell phones, handheld video games, hats, food, drinks, or gum are not allowed in the classrooms. Students are expected to respect teachers, staff, classmates and the SMARTS Facility at all times. If a student’s behavior disrupts class or creates a safety problem, the following will occur: 1st offense: Warning 2nd offense: Conference with parents 3rd offense: Removal from class and withdrawal from SMARTS student rotation for one semester (two sessions). The SMARTS Executive Program Manager reserve the right to skip offenses, depending on previous actions and safety concerns. Upon signing this contract, we agree to follow the directions of the SMARTS teachers and staff, as well as the rules and regulations associated with SMARTS.Student's E-Signature*Parent's E-Signature*By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.