Skype lessons provide the perfect opportunity for students to not loose momentum nor progress of routine lessons. If someone is sick, the transportation is not available for a specific lesson or one of us is out of town, SKYPE lessons will keep the lessons flowing and going. Contact Sujoy directly for details on how to get the best out of a SKYPE lesson; where to sit in relationship to the camera and microphone, how to have music ready for both the teacher and student prior to start of lesson, payment options for Skype lessons etc.
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Sujoy Strings Spring Jam
March 27, 28, 29, 2020
Music Camp Registration Form
$50/person non-refundable deposit due with form
All Credit Card transactions add 3% fee
Total camp cost per musician $160
Total camp cost per Non Musician $130
Non musician family members under age 12 $110
Limited scholarships available
Final payment due 10 days prior first day of Spring Jam
Student Name ___________________________________ Circle: Male Female DOB: ______/_______/______
Home Phone ____-______-_______ Cell Phone ____-______-_______ Email: __________________________
Street address: ______________________________ City: _____________________Zip Code _____________
Parent / Guardian (if under 16 years of age) ______________________________________________________
Parent: Email __________________________ Parent Phone ____-______-_______
Musicians 16 years of age and older are not required to have an adult family member/friend attend.
Private Music Teacher (if any) ________________________ Phone ____-______-_______
Years played on primary instrument: ______ Music Currently Working On ____________________________
How did you hear about the Spring Jam Camp? __________________________________________________
Instrument(s): Circle those you will bring: Violin/Fiddle Viola Cello Bass Keyboard (no pianos provided, bring batteries) Guitar Banjo Dulcimer Harmonica Recorder Other: ______________________________________
Food Allergies (if any) _______________________________________________________________________
ADDITIONAL EMERGENCY CONTACT other than Parent / Guardian listed above
Name ________________________________ Relationship to Student __________ Phone ________________
Additional NON MUSIC CAMPER Family Members also attending Spring Jam
Name_______________________________________________________________ Adult_____ or Age _____
Instrument(s)_______________________________________________________________________________
Name_______________________________________________________________ Adult_____ or Age _____
Instrument(s)_______________________________________________________________________________
Name_______________________________________________________________ Adult_____ or Age _____
Instrument(s)_______________________________________________________________________________
Contact: Sujoy Spencer • SujoyStrings@aol.com • 470-223-2342 • www.SujoyStrings.com
Checks made payable to “Sujoy Spencer.” Please write “Spring Jam” on memo line.
Mail application and registration fee to Sujoy Spencer, 7344 N. 22nd Place, Phoenix, 85020
Space is limited; please submit registration and non-refundable deposit per person soon.
Attach a separate page if additional space is needed for information.
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First name: ______________ Last name: _________________________________
Please indicate level of playing ability / experience.
PLEASE CHECK ALL THAT APPLY
If more than one instrument, please list for each. Indicate main instrument choice.
Main instrument ___________________
_____ Level 1 Beginner; have played for 2 years or less.
_____ Level 2 Advanced beginner; has played for 2 to 3 years, begun shift positions I & III
Cello can do extensions in position I
_____ Level 3; Plays I and III positions comfortably (violin & viola)
I through IV positions with extensions (cello)
_____Level 4; Plays I, II, III, IV position (violin & viola)
Reads tenor and treble clef (viola)
Reads bass and tenor clef (cello)
_____ Level 5; Plays comfortably in all positions,
has or will be auditioning for Regionals/ Allstate or is at that level.
Second instrument (if any) ___________________
_____ plays by ear only
_____ self-taught
_____Level 1 Beginner; have played for 2 years or less.
_____Level 2 Advanced beginner; has played for 2 to 3 years, begun shift positions I & III
Cello can do extensions in position I
_____Level 3; Plays I and III positions comfortably (violin & viola)
I through IV positions with extensions (cello)
_____Level 4; Plays I, II, III, IV position (violin & viola)
Reads tenor and treble clef (viola)
Reads bass and tenor clef (cello)
_____Level 5; Plays comfortably in all positions,
has or will be auditioning for Regionals/Allstate or is at the level.
Second instrument (if any) ___________________
_____ plays by ear only
_____ self-taught
_____Level 1 Beginner; have played for 2 years or less.
_____Level 2 Advanced beginner; has played for 2 to 3 years, begun shift positions I & III
Cello can do extensions in position I
_____Level 3; Plays I and III positions comfortably (violin & viola)
I through IV positions with extensions (cello)
_____Level 4; Plays I, II, III, IV positon (violin & viola)
Reads tenor and treble clef (viola)
Reads bass and tenor clef (cello)
_____Level 5; Plays comfortably in all positions,
has or will be auditioning for Regionals/Allstate or is at that level.
TEMPORARY POWER OF ATTORNEY FOR LIMITED GUARDIANSHIP OF MINOR
I,(Parent/Guardian)______________________________________, do hereby willfully and
voluntarily appoint_____________________________________________
of Street Address____________________________________
City_______________ State_____ Zip___________
as my attorney-in-fact and Agent, with lawful authority to temporarily act as guardian of
my minor child:
Child Name:________________________________ Date of Birth:____________________
This Temporary Power of Attorney hereby grants my Agent the same rights that I personally possess under other circumstances, including consent to emergency medical care, solely
while traveling for and attending the Spring Jam music camp in Prescott, Arizona
beginning ______________, 20___ and ending ______________, 20___
or until my child is returned to my custody.
Clearly Printed name____________________________________
Signature of Parent/Guardian_____________________________Date____________
STATE OF _____________________
County of ____________________
On the _______ day of _________________, 20___, before me personally appeared
__________________________________________________________ who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same.
Notary Public_________________________________________
My commission expires: ______________________