FilmConservatory20112012

APPLICATION
GeneralInformation:
ChildsLastName

FirstName

BirthDate

HomeAddress

Zip

HomePhone

School

______

GradeinFall2011

PreviousSchools

Parent/Guardian(1)

__

Parent/Guardian(2)

______________

DayPhone(1)

DayPhone(2)

CellPhone(1)

CellPhone(2)

Email(1)

Email(2)

Childscellphone,ifapplicable

ChildsEmail

EmergencyContact*Relationship

Phone

*AnAdultrelative,neighbor,orcaretaker.Pleaselistthenumbertheycanbereachedduringclass.

TeacherRecommendationApplicantsforthiscoursemustsubmitateacherrecommendation
AspartoftheapplicationfortheFilmConservatory,werequirestudentstosubmita
recommendationfromateacher.Thisrecommendationmaycomefromanacademicteacher
oraperformingartsormediaartsinstructor.PleaseusetheattachedTeacher
RecommendationForm.

HOWDIDYOUHEARABOUTUS?__________________________________________________

FilmConservatory20112012
PleasereadtheinformationonthebackandSIGNyourname
MAIL APPLICATION AND TEACHER RECOMMENDATION TO:

IMAGINE ME KIDS
Attention: Film Conservatory
366 Amsterdam Avenue
SUITE 221
NEW YORK, NY 10024

FilmConservatory20112012
Terms and Conditions of Participation in
Imagine Me Kids Film Conservatory
Iunderstandandagree:
1)
thatifmychildisacceptedintotheFilmConservatory(hereafterreferredtoas
TheProgram),IamresponsibleforsubmittingtuitionpaymentbyNovember3,2011to
insuremychildsenrollmentintheprogram;
2) thataftersubmittingtuitionIshallnotbeentitledtoanydeductionformychilds
absencesorillnessesduringtheProgram;thatintheeventofmychilds
withdrawalorsuspensionfromtheProgramafterclasseshavestarted,Ishallnot
beentitledtoanyrefundofunusedtuition;
3) thatImagineMeKidsrequiresmychildtomeetcertainstandardsofbehavior
andthatifmychildfailstobehaveordemonstratesrepeatedunsatisfactory
conduct,ImagineMeKidshastherighttodismissmychildfromtheProgram;
4) thatImagineMeKidsreservestherighttochangeinstructorsandroom
assignmentsasnecessary,ortocancelclassesnotmeetingminimumenrollments;

5) thatifmychildisnotpickedupby8:10PMonThursdaysor6:10pmonSundays,
Iagreetopaylatenessfeesaccordingtopolicy,andthatmychildmaybetaken
tothe20thPrecinctintheeventnooneisavailabletosupervisemychildonehour
afterdismissal;
6) thatifmychildisinjuredandrequiresmedicalattentionandIcannotbereached
forinstructions,IdoherebygiveauthoritytoImagineMeKidsanditsteaching
artiststoobtainnecessaryemergencymedicaltreatmentformychildwiththe
understandingthatthefamilywillbenotifiedassoonaspossible;
7) thatinconsiderationofImagineMeKidsconductingtheProgramandallowing
mychildtoparticipateinsuchprogram,Iherebyreleaseandforeverdischarge
ImagineMeKidsanditsofficers,volunteers,employees,contractors,andagents
fromanyliabilityarisingoutoforbaseduponanybodilyinjuryorproperty
damagewhichmaybesustainedbymychildwhileparticipatinginsuch
program;
8) thatduringtheProgramactivitiesmychildmaybephotographedorfilmedby
ImagineMeKidspersonneloritsauthorizedagentsforinternalorpromotional

FilmConservatory20112012
use;
9) thatsomeFilmConservatoryactivitiesmayinvolvetripsoutsidethebuilding
wheretheProgramisheld,supervisedbystaffoftheProgram.Igivemychild
permissiontogoonanysuchtrips,orfilmshoots,organizedaspartofthe
Program,including(butnotlimitedto)neighborhoodlibraries,parks,museums,
andotherschools.

Parent/guardiansignature_______________________________________
Date__________

FilmConservatory20112012
TeacherRecommendationForm
ChildsLastName

FirstName

Teacher

ContactPhone

Email

NameofSchoolorOrganization(ifapplicable)

City

ZipCode

Iamtheapplicant's(pleasecheckallthatapply):
ClassroomTeacher

Mediaartsinstructor

Academicspecialty(English,

Other,pleasedescribe

mathematics,science,etc.)

_________________

PerformingArtsinstructor

___

___

___

Howlongandinwhatcapacityhaveyouworkedwiththisstudent?
_______________________________________________________________________

Whatdoyouconsidertobethispersonsstrongestqualitiesortalents?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Whatthreewordsimmediatelycometomindwhenthinkingofthisstudent?
_____________________________________________________________________________

Inwhatareasdoesthestudentshowthegreateststrengthand/orcreativity?
_____________________________________________________________________________

FilmConservatory20112012
_____________________________________________________________________________

Inwhatareadoesthestudentneedtoimprove?
_____________________________________________________________________________
_____________________________________________________________________________

Howwouldyoudescribethestudentsrelationshipwithpeers?
_____________________________________________________________________________

_______________________________________________________________________
______
Wewelcomeanyothercommentsyouhavethatwouldbehelpfulin
evaluatingthisstudent:
_____________________________________________________________________

_______________________________________________________________________
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