Scholarship Application Scholarship Application If you are human, leave this field blank. Parent/Guardian Information Parent/Guardian First Name * Parent/Guardian Last Name * Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Country Phone Number * Type of phone number * Home Cell Can you recieve texts at this phone number * Yes No Email Address * Relationship to student * Who will be bringing your child to class, and what is their relationship to the child? * Student Information Student's Name * Date of Birth * Age * Gender Male Female Special Needs/Concerns Sibling information - Please list the name(s) and age(s) of any siblings. Class Registration Please select your first and second choice for free trial class. The second choice is used if your first choice class is already full. You can view our current schedule on our website Please list the day and time of the classes you prefer. (view the schedule on our website to see the available class times) Do you need FREE sibling childcare for Village and/or Our Time classes? Yes No If you need free sibling childcare during your Village or Our Time preview class, please enter the sibling names and ages: How did you hear about us? Comments If you were referred by a friend, please provide your friend's name. Scholarship Information What assistance are you looking for? * Describe your extenuating circumstances. * List and describe all other activities all the children in the family are involved in. What is your average annual household income? Please select one. * $0-18,000 $18,000-$35,000 $35,000-$60,000 $60,000-$90,000 Above $90,000 Other information you want to be considered: How much can you afford to pay per month? * Enrollment Policies If approved for a partial or full scholarship, I commit to consistent and punctual attendance, use of the home materials for reinforcement, and confidentiality of receipt of the scholarship. I understand Kat's Musik will charge installment payments on a recurring monthly basis for at least 2 payments. After the first two charges, if I need to cancel or pause my enrollment, written notice should be given to Kat's Musik prior to the 20th of the month. I understand all account changes are processed at the end of the month and take effect the following month. A NSF fee of $20 may be assessed for any declined electronic funds or late payments. Kat's Musik has permission to email me class-related information and announcements. I understand that my personal information will not be released to any third party, and is for the exclusive use of communication from Kat's Musik. Kat's Musik has my permission to use photographs or video of myself or my child taken at Kat's Musik's classes, lessons, or special events. With this enrollment, I have released any and all rights and claims for damages against Kat's Musik and its Staff in the unlikely event of injury sustained by myself or my child(ren) during the course of or as a result of my enrollment at Kat's Musik. Agreement * I have read and agree to abide by the above stated policies of Kat's Musik.