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Fields marked with an * are required Part 1: Main Contact Parent/Guardian 1 Name * Cell Phone (if applicable) Work Phone (if applicable) Address * City * County * State * --Please Select-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code * Email * Best way to contact this person (cell, email, etc.) * Number of people in household * Number of dependent children * Parent/Guardian 2 (if applicable) If not applicable, please skip to Part 2 Parent Guardian 2 Name Cell Phone (if applicable) Work Phone (if applicable) Address City County State --Please Select-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Email Best way to contact this person Part 2: Child Information Name of Camper * Date of birth (mm/dd/yyyy) * Age * Gender * FemaleMaleNon-BinaryPrefer Not To SayOther Ethnicity (select all that apply) * AsianBlack/AfricanCaucasianHispanic/LatinxNative AmericanPacific IslanderPrefer Not To AnswerOther Does this child have diagnosed special needs? * YesNo If "Yes", please describe. Choose one * Explore! Music CampBelt It OutHouse of RockBluegrass Camp Camp Session Dates * Explore! Music Camp - Appalachian (June 4-8) @ LowryExplore! Music Camp - Rock n' Roll (June 18-22) @ YaleExplore! Music Camp - Jazz (July 9-13) @ LowryExplore! Music Camp - World (August 6-10) @ YaleBelt It Out! Performance Camp - (July 7-13) @ YaleHouse of Rock - First Band Experience (June 4-9) @ YaleHouse of Rock - Second Band Experience (June 11-16) @ YaleHouse of Rock - Advanced Camp: 'OK Computer' by Radiohead (June 18-23) @ YaleHouse of Rock - Intermediate/Advanced Camp: The Reign of Punk (July 16-21) @ YaleHouse of Rock - Songwriting/Recording *2-week camp* (July 23-August 3) @ YaleBluegrass Camp - (August 13-17) @ Yale Has the child attended a Swallow Hill Music Camp before? * YesNo If "Yes", for how many years? Have you applied for Tuition Assistance from Swallow Hill Music before? * YesNo Camp Questions Emergency Contact Name * Emergency Contact Phone Number * Insurance Provider Name (if applicable) Insurance Provider Phone Number (if applicable) Known Allergies Medications (if applicable) Instrument (if applicable) Part 3: Narrative Information Please check any extraordinary circumstances listed below that are relevant to your family's capacity to pay for camp: A child with diagnosed special needs in the homeSingle-parent householdUninsured medical expensesRecent job lossOther Please list any other circumstances not listed previously Please provide a short description from the child of why they want to attend camp at Swallow Hill Music. * Annual Household Income * Do you qualify for any of the following programs? (check all that apply) Food stampsMedicaidEIC (Earned income credit)Social Security/Disability Application Checklist * 1040 Tax Return (Please send this as an e-mail attachment to bren@swallowhillmusic with the subject line "Tuition Assistance Application Documents)1-Month of Paycheck Stubs (Please send this as an e-mail attachment to bren@swallowhillmusic with the subject line "Tuition Assistance Application Documents) Tuition Assistance Guidelines and Policies Upon completion of the tuition assistance application, you will be notified of your award within a week. Please be sure to include all information, including financials. A student currently on tuition assistance who wishes to continue from one session to the next will contact Brennalynn Flaherty at bren@swallowhillmusic.org or 303-643-5804. This ensures that the Tuition Assistance Committee is informed of their intent within a timely manner. Tuition assistance awards vary depending on financial and personal situations. The remaining balance will remain on the student account as an invoice. This invoice is to be paid by the end of the camp. Students must be respectful, engaged, and motivated while in the camp. Instructors and staff will communicate behavior issues. If these issues continue, the tuition assistance will be forfeited. In order to meet the expectations of the class, students will be expected to do their part in practicing the material for the week. We typically suggest 15 minutes daily. Within two weeks of completion of your or your child's course or camp, please e-mail Brennalynn Flaherty with a short paragraph on your/your child's musical experience and what the scholarship opportunity meant to you and/or your family. Please note if we may use you/your child's first name or if you prefer to be anonymous. Testimonials will be used in Swallow Hill Music's online and print publications. In addition, photos are appreciated and may be used in online or print publications. * Permission to use nameAnonymous Thank you for completing this application. Please expect to hear back from us within one week of your submission! Thanks!
