El Sistema Aeolian Returning Application

Apply (Returning)

NOTE: This form only to be filled out by returning applicants. New applications via this form will not be accepted.

ESA Returning Applicant's Form

Application Date*
MM slash DD slash YYYY
Applicant Child's Name*
First Last
Date of Birth*
MM slash DD slash YYYY
School Attending (2022-2023 School Year)*
Grade Entering in September*
Parent or Guardian Information: Name*
First Last
Relationship to Child*
Specify
Address*
Street Address Address Line 2 City Province Postal Code
Primary Phone Number*
Primary Phone Number*
Secondary Phone Number
Secondary Phone Number
Email*
Enter Email Confirm Email
Best way to contact you during ESA hours:*
Alternate Contact Information: Name*
First Last
Relationship to Child*
Specify
Address*
Street Address Address Line 2 City Province Postal Code
Primary Phone
Primary Phone Number
Email
Enter Email Confirm Email
Best way to contact you during ESA hours:*
I/we intend to support my/our child to fulfill the time commitment that belonging to the program represents and to fully engage in all the program's classes and activities. When a participant doesn’t fulfill the time commitment, their spot will be offered to an applicant in the waiting list.*
- Yes
- No
I/we understand my/our responsibility for timely drop off and pick up times for my/our child to participate in El Sistema Aeolian.*
- Yes
- No
I/we understand that El Sistema Aeolian is entirely run by The Aeolian and it is both a musical program and a social program, focusing on helping children and youth achieve their full potential and be their very best. This program is designed to develop leadership skills, cooperation, and teamwork. We understand that the program provides instruction, instruments, classroom and studio space, meals, and other program activities at no cost to the child's family (note: this is equivalent to a $3,500 scholarship per school year).*
- Yes
- No
I give permission for my child’s picture and video to be taken and used to promote the program.*
I give permission for my child’s name to be printed in programs and promotional material*
I give permission for my child to share in meals and snacks while attending the program*
I give permission for the free exchange of information between my child’s school and El Sistema Aeolian*
I give permission to El Sistema Aeolian program to send me emails and newsletters*
I understand that youth within the program are required to remain within the confines of El Sistema Facilities at all times during the program session and not to leave the building without their guardian’s written consent.*
I understand that attendance is very important to the program and should my child need to miss a session we will notify the El Sistema Aeolian office prior to the session either by email to elsistema@aeolianhall.ca or calling (519)679-2220*
Please list name(s) and phone number(s) for those who will be picking up your child and/or specify if your child is responsible for getting themselves home.*
Please list any medical condition/allergies (including food allergies) that we should be aware of:*
I understand that, in case of a medical issue affecting a participant child we will make every effort to contact the parent/ guardian, but if the issue is perceived to be a medical emergency the program will seek immediate professional care*
Please list any after school activities your child gets involved with during the school year, including sports and private lessons (music or other). List schedule if applicable.*
Are there any issues or barriers with getting your child to and from the ESA classes on time?*
Part of teaching a musical instrument involves some physical contact with the student. Guiding hands, arms and general posture is often required. Are you and your child comfortable with this?*
Please indicate any special health or learning needs that we should consider or know about (including learning disabilities, food allergies, etc). Please note, should a child have a serious condition that requires use of a puffer or epipen to stop the child having a major health issue, the program will require that you supply us with a device that we will store on site for any such emergency as well as training to Program Coordinators by the parent in the use of the device to allow them to assist the child if necessary.*
ESA relies on community support to achieve its objectives. Would you be interested in getting involved to support the program in any way?*
Is there anything necessary to tell us since your last application that may affect your child’s commitment to the program?*
Number

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