Student Registration

I. Student Information:

Tell us about yourself

Name*

First Last

Birth Date*

Age*

Gender*

Male
Female

School Attending*

Current Grade*

Any medical conditions SMARTS staff should know for the safety of your child?

If none, please type none

II. Parent/Guardian Information:

Name*

First Last

Are you a resident of Youngstown?*

Yes
No

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Secondary Phone*

Email*

Required so we can send you class information

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.

III. Authorized Adult for Pick-Up

List any names of authorized adults who may pick up your child other than yourself

Authorized Guardian Pick-Up (other than listed above)

First Last

Relationship

Phone

IV. Emergency Information:

Person to contact in case of emergency OTHER THAN PARENT/GUARDIAN*

First Last

Relationship*

Phone*

Secondary Phone

V. Student Interests

Please select the areas that interest your student.*

Please order your interest from the selection to the left from MOST to LEAST interested.*

Would you take the first class available?*

Yes
No

Do you own or rent a musical instrument? If yes, what instrument?*

Yes
No

Instrument

Have you ever taken any private lessons in the arts?*

Yes
No

VI. Statistical Information

This is for statistical purposes only.

Number of people in household

Combined income level for my household

$10,000-$18,000
$18,000-$30,000
$30,000-$50,000
over $50,000

Ethnic Origin

Hispanic
Non-Hispanic

Race (choose ALL that apply)

SMARTS Media Release

I, ________________________, 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-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.

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.

SMARTS Student Application

I. Student Information:

II. Parent/Guardian Information:

III. Authorized Adult for Pick-Up

IV. Emergency Information:

V. Student Interests

VI. Statistical Information

SMARTS Media Release

VII. SMARTS Admissions Policy: