Mariachi Jump Start Registration Form
Student First Name:
Student Last Name:
(Please note that there is a limited quantity of instruments which will be checked out to students on a "first come, first served" basis. Selecting this option does not guarantee that we will be able to provide an instrument for the student. Please contact us for inquiries regarding instrument availability.)
In case of an emergency, we will attempt to contact the parent/guardian using the phone number entered above. Since your child's safety and wellbeing are of utmost importance, we ask that you also provide an additional emergency contact in case the parent/guardian cannot be reached.
1. I understand that Mariachi Aguilas and St. Albert the Great Newman Center will NOT provide insurance coverage or compensation for any medical care needed due to my child's participation in the Mariachi Jump Start summer program.

2. I understand that Mariachi Aguilas and St. Albert The Great Newman Center are NOT liable for any lost, stolen, or damaged personal property during the course of the Mariachi Jump Start summer program.

3. I understand that there are certain risks and hazards that may arise in the course of this summer program and hereby assume the inherent risks and hazards of my child's participation in the Mariachi Jump Start summer program.

4. I acknowledge that claims for against Mariachi Aguilas or St. Albert the Great Newman Center will be governed by the laws of the State of New Mexico.

5. I hereby grant permission for Mariachi Aguilas and St. Albert the Great Newman Center to use photographs and/or videos of my child taken during the Mariachi Jump Start summer program, with or without their name, for any lawful purposes such as publicity, illustration, advertising and web content.
By typing my name below, I certify that I agree with the statements above.
(Note that the Youth L and the Adult S are the same size, except in length. Adult sizes are longer than Youth sizes.)
Please read the following statements carefully.
Which grade level will the student be entering in the upcoming (2019-2020) school year?
5th Grade
6th Grade
7th Grade
8thGrade
9th Grade
10th Grade
11th Grade
12th Grade
Which instrument workshop is the student interested in taking?
Violin
Trumpet
Guitar/Armonia
GuitarrĂ³n
Does the student have access to the selected instrument?
Yes, the student will bring their own instrument to the workshop.
No, the student will need to borrow an instrument for the workshop.
Does the student have any previous experience playing the selected instrument?
No, the student has no previous experience playing instruments.
No, the student has never played this instrument, but does play a different one.
Yes, the student has been playing this instrument for less than 1 year.
Yes, the student has been playing this instrument for 1 to 2 years.
Yes, the student has been playing this instrument for more than 2 years.
What is the student's T-Shirt size?
Youth XS
Youth S
Youth M
Youth L *
Youth XL **
Adult S *
Adult M **
Adult L
Adult XL
Adult XXL
- Non-refundable $50 registration fee includes: 20 hours of instruction, participant T-Shirt*,
workshop folder with sheet music, and a light snack for each workshop day.
- After this form is submitted, you will be automatically redirected to our payment page.
Payment must be submitted immediately following the submission of this form in order for
registration to be completed. Please call (575)649-0142 for information/troubleshooting.
*T-Shirt availability not guaranteed if registration is submitted AFTER June 5th, 2019.
3rd Annual Mariachi Jump Start Summer Program - June 10th to June 14th, 2019.
Workshops at St. Albert the Great Newman Center from 8:00am to 12:00pm.
Showcase Concert - June 14th, 2019 at Young Park at 6:30pm.
Date of Birth:
School:
Does the student have any known food allergies? If so, please list.
Does the student have any medical conditions that require close monitoring or special accommodations? If so, please explain.
Parent/Guardian First Name:
Parent/Guardian Last Name:
Parent/Guardian Phone Number:
Parent/Guardian Email Address:
Home Address: (Full Street Address, City, State and Zip Code)
Emergency Contact First Name:
Emergency Contact Last Name:
Emergency Contact Phone Number:
Relationship to Student:
Parent/Guardian Electronic Signature:
Today's Date: