MMPA SUMMER 2024 CAMP REGISTRATION

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

We are excited to offer a fresh schedule of music, theatre, art, and dance camps that will engage students in self-expression, creativity, and community through the arts! Our 2024 Summer Camps will all take place at the MMPA Studio at 3801 Delridge Way SW. Families have the option to choose either the morning or afternoon camps or sign up for both for double the fun!

STUDENT INFORMATION

First Name *

Last Name *

Gender

Preferred Pronouns

Birth Date * +

Grade (if applicable)

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

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CONTACT INFO

PRIMARY ADULT (to be used as the Emergency Contact)

Relationship to Student: *

First Name *

Last Name *

Address *

City *

State *

Zip *

Phone *

Alternate Phone

Email Address *

SECONDARY ADULT

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

CAMP SELECTION

NOTE: If you are signing up for both the morning and afternoon camps, a teacher will be on-site between 12-12:30 to supervise the lunch break. Please be sure to pack a lunch for your child if they are staying for a full day of camps.

July 1-3 Mini Camp!

*For these camps only, you are signing up for the FULL DAY (9 am - 3:30 pm), for ALL 3 days @ $400*

Select the camp(s) you wish to enroll in below.

Theatre 101 (K-5) - CLOSED

IF the camp you want is full, we can add you to a waitlist! Select your waitlist requests below or email education@modemusicandperformingarts.org

Theatre 101 (K-5) WAITLIST

MORNING CAMPS

Choose one or more weeks of 9am-12pm camps @ $325

Select the camp(s) you wish to enroll in below.

6/24-6/28: Broadway Dance Party (K-2) OPEN - Only a few spots left!

7/8-7/12: Broadway Dance Party (grades 3-5) OPEN

7/15-7/19: Ukulele 101 (K-2) OPEN

7/22-7/26: Theatre Behind the Scenes (grades 3-5) OPEN

7/29-8/2: Star Wars Play Creation (K-2) OPEN - Only a few spots left!

8/5-8/9: Improv Workshop (grades 3-5) OPEN - Only a few spots left!

8/12-8/16: Music Theory 101 (K-2) OPEN

8/19-8/23: Music in the Movies (grades 3-5) OPEN

8/26-8/30: Songwriting & Beatmaking (grades 6-8) OPEN

IF the camp you want is full, we can add you to a waitlist! Select your waitlist requests below or email education@modemusicandperformingarts.org

6/24-6/28: Broadway Dance Party (K-2) WAITLIST

7/8-7/12: Broadway Dance Party (grades 3-5) WAITLIST

7/15-7/19: Ukulele 101 (K-2) WAITLIST

7/22-7/26: Theatre Behind the Scenes (grades 3-5) WAITLIST

7/29-8/2: Star Wars Play Creation (K-2) WAITLIST

8/5-8/9: Improv Workshop (grades 3-5) WAITLIST

8/12-8/16: Music Theory 101 (K-2) WAITLIST

8/19-8/23: Music in the Movies (grades 3-5) WAITLIST

8/26-8/30: Songwriting & Beatmaking (grades 6-8) WAITLIST

AFTERNOON CAMPS

Choose one or more weeks of 12:30-3:30 camps @ $325

Select the camp(s) you wish to enroll in below.

6/24-6/28: Fairytale Play Creation (K-2) OPEN - Only a few spots left!

7/8-7/12: Superhero Scene Study (grades 3-5) OPEN

7/15-7/19: Story Drama (K-2) OPEN

7/22-7/26: Musical Theatre Revue (grades 3-5) OPEN

7/29-8/2: Songwriting Workshop (K-2) OPEN

8/5-8/9: Harry Potter Scene Study (grades 3-5) OPEN

8/12-8/16: Musical Theatre Revue (K-2) OPEN - Only a few spots left!

8/19-8/23: Songwriting Workshop (grades 3-5) OPEN

8/26-8/30: Vocal Performance (grades 6-8) OPEN

IF the camp you want is full, we can add you to a waitlist! Select your waitlist requests below or email education@modemusicandperformingarts.org

6/24-6/28: Fairytale Play Creation (K-2) WAITLIST

7/8-7/12: [THEME] Scene Study (grades 3-5) WAITLIST

7/15-7/19: Story Drama (K-2) WAITLIST

7/22-7/26: Musical Theatre Revue (grades 3-5) WAITLIST

7/29-8/2: Songwriting Workshop (K-2) WAITLIST

8/5-8/9: Harry Potter Scene Study (grades 3-5) WAITLIST

8/12-8/16: Musical Theatre Revue (K-2) WAITLIST

8/19-8/23: Songwriting Workshop (grades 3-5) WAITLIST

8/26-8/30: Vocal Performance (grades 6-8) WAITLIST

DEMOGRAPHIC INFORMATION (Optional)

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

If other, please specify here:

STANDARD PHOTO/VIDEO RELEASE FOR MINORS

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. *

I DO give my permission

I DO NOT give my permission

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.

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

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PAYMENT

*Please indicate partial or full scholarship below if you require a scholarship for classes.*

Discounts for multiple classes will be applied after checkout. Please contact 206-659-0463 or email billing@modemusicandperformingarts.org with any questions.

Please select an optional partial or full scholarship below.

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.

Enter your coupon code here:

If you are using a gift certificate, enter your code for $100 off here:

Please enter below any amount you would like to donate to our programming here at MMPA. This can help another student attend these courses, when they normally would not due to lack of funds.

Current Total:

$0.00

CANCELLATION POLICY

- If a camp is canceled by MMPA: Full refund.

- Withdrawals more than 2 weeks before the start of the program: Full refund for each student registration, less $50.

- Withdrawals 2 weeks or less before the start of the program: 50% refund.

- Switching between programs is allowed, based on availability. There is a switching fee of $25 per switch.

COMPLETION

How did you hear about us? *

Completion of this form will automatically subscribe you to our Mode Music Studios newsletter. This is a monthly publication that includes information on upcoming events, private lesson deals, and upcoming MMPA enrichment sessions. You can opt out at any time.

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. *

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