MODE MUSIC AND PERFORMING ARTS FALL 2024 STUDIO CLASSES

Mode Music and Performing Arts
3801 Delridge Way SW
Seattle WA 98106
http://www.modemusicandperformingarts.org

Join us this season for fun-filled, in-studio classes that will engage students with a creative, interactive curriculum in a variety of arts disciplines! If you have any questions, please don't hesitate to contact us via education@modemusicandperformingarts.org.

STUDENT INFORMATION

First Name *

Last Name *

Pronouns

Birth Date * +

Grade *

Does the student have any medical, learning, behavioral, or other special considerations/circumstances of which we should be aware? If yes, please explain: *

0/200 words

CONTACT INFO

PRIMARY ADULT

Relationship to Student: *

First Name *

Last Name *

Address *

City *

State *

Zip *

Phone *

Alternate Phone

Email Address *

SECONDARY ADULT/EMERGENCY CONTACT

Relationship to Student: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Street Address

Address Line 2

City

State

Zip Code

Phone Number *

Email Address

CLASS SELECTION

When you select a class, you are signing up for a total of 10 weekly sessions. The fee for 10 weeks of each class is $260. (D&D is $520 since the duration of the class is 2 hours rather than 1.) If you need to take advantage of our pay-what-you-can or scholarship options, you can do so in the "Payment" section.

Classes run from Monday, September 30th through Monday, December 16th.

*There will be NO CLASSES Monday 11/11 due to Veteran's Day, and closed 11/25-11/29 for the Thanksgiving holiday.*

Monday

Intro to Visual Arts *Grades 2-5* (5:30 pm - 6:30 pm)

Visual Arts: Studio Skills *Grades 6-12* CLOSED

Tuesday

Dungeons & Dragons Campaign *Grades 3-5* (4:00 pm - 6:00 pm)

Dungeons & Dragons Campaign *Grades 6-8* CLOSED

Wednesday

Intro to Songwriting *Grades 3-5* (5:30 - 6:30 pm) CLOSED

Songwriting Workshop *Grades 6-8* CLOSED

Thursday

Drama Adventures *Grades K-2* (4:00 pm - 5:00 pm)

Theatre Games *Grades 3-5* (5:30 pm - 6:30 pm) CLOSED

Improv *Grades 6-8* (7:00 pm - 8:00 pm) CLOSED

Friday

Creative Movement *Grades K-2* CLOSED

PAYMENT

*If you are using the Pay What You Can option, please select a 100% scholarship and then enter the amount you are able to pay below.*

Scholarships are available for any and all! Please select partial or full scholarship below.

Current Total:

$0.00

We also offer Pay What You Can. Please enter the amount you are able to pay below, after requesting a 100% scholarship. No student will be turned away for lack of funds.

Please enter below any amount you would like to donate to our programming here at MMPA. This helps us continue to provide classes to families in need of free and reduced rates!

DEMOGRAPHIC INFORMATION

Any and all demographic information is optional and any answers will be confidential. Demographic information received will be used by MMPA to receive funding to keep the cost of our programs affordable to all students. Please complete this section to the best of your ability & comfort level.

Race/Ethnicity

If you wish to self describe how the student identifies themselves in terms of race or ethnicity, please specify here:

Household Size

Annual Household Income

Primary Language Spoken at Home

COVID-19 SAFETY PROTOCOL

I, the undersigned, agree to help protect the health and safety of all MMPA students and staff by adhering to the following protocol:

- If either parent or child is exhibiting symptoms of illness (i.e. fever, headache, sore throat, stuffy/runny nose, fatigue, etc.), I will notify MMPA and stay home. We will not return to class until the symptoms subside.

- If any member of my household has known exposure to COVID-19, I will notify MMPA immediately so that they can communicate with the families of classmates.

- Masks are optional. We encourage you to do whatever makes you feel most comfortable. *

clear

PHOTO/VIDEO RELEASE

*

I give my permission.

I DO NOT give my permission.

Mode Music and Performing Arts (“MMPA”) is requesting permission to use images and videos from our programming for the purpose of advertising and for the promotion of our non-profit to charitable foundations so we can continue to provide art classes and music lessons to all children, regardless of income. I hereby allow MMPA to use images of my child in these applications and requests. MMPA will notify me of classes that will be recorded or have screen images captured prior to the class. *

clear

HOW DID YOU HEAR ABOUT US?

*

COMPLETION

I, the undersigned parent/guardian of the registrant, acknowledge the possibility that participation in Mode Music and Performing Arts activities could result in physical injury to the registrant. I hereby release, discharge and agree to hold harmless Mode Music and Performing Arts, its officers, directors, employees, agents and affiliates from any and all claims arising from or related to the registrant’s participation in Mode Music and Performing Arts activities. I certify that I have read, understood, and agree to the above conditions, and that the information provided is complete and accurate to the best of my knowledge. *

clear