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Student Registration Form, 2011-2012
Please Print Clearly and Complete All Sections of All Sheets
Student Information
Returning Student
Date: ___________________________
New Student
Name: ________________________________
Male
Female
Birth Date: _______________________
month/day/year
Address: _______________________________
_______________________________
Age: _______
School: __________________________
Home phone: ___________________________
Grade: _________
Student cell phone: ______________________
Student Email: _____________________
Medications, medical conditions, allergies or information you would like us to know? __________________
_____________________________________________________________________________________
Guardian Information (include all legal guardians)
Name: _________________________________ _
Name: __________________________________
Address: _________________________________
Address: ________________________________
Home Phone: _____________________________
Home Phone: ____________________________
Cell Phone: _______________________________
Cell Phone: ______________________________
Employer: ________________________________
Employer: _______________________________
Work Phone: ______________________________
Work Phone: _____________________________
Email Address: _____________________________
Email Address: ___________________________
Relationship to Student: ______________________
Relationship to Student: ____________________
In case of emergency, if we are unable to reach a parent/guardian, whom should we contact?
Name: ____________________________________
Daytime phone: ___________________________
Relationship to Student: ______________________
Evening Phone: __________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When finished with their lesson or class at Infinity:
 My child is to wait within the Infinity facility until one of the listed guardians arrives to pick them up.
 My child has my permission to leave the Infinity facility independently, wait outside, etc.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Infinity Staff Use Only
Start Date: __________ Session day/time: _______________ Instructor: __________________ Instrument: ______________
Start Date: __________ Session day/time: _______________ Instructor: __________________ Instrument: ______________
Infinity Visual and Performing Arts, Inc.  115 East Third Street  Jamestown, NY 14701  (716) 664-0991
FAX 716-664-4220  info@infinityperformingarts.org  www.infinityperformingarts.org
Explore!
Experience!
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Which Infinity program(s) are you interested in?
Music
Art
Dance Theater
Other _________________
Music Information:
 Private Lessons - Please circle your first choice and  any others you may be interested in.
Piano
Drum Set
Voice
Steel Drums
Saxophone B3 Organ
Acoustic Guitar Electric Guitar
Hand Drums
Violin
Trombone
Flute
Bass Guitar
Classical Guitar
Trumpet
Digital/Audio Production
Other: ____________________________
Do you currently own/rent any instruments? No
Yes __________________________________
Have you received any musical instruction? No
Yes
If yes: instrument, length of time played, and name(s) of instructor or program: ________________
____________________________________________________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Help us decide what workshops/classes to offer by checking  ideas below that interest you:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Music:
Jazz Ensemble
Blues Ensemble
Classical Ensemble
Steel Drum Ensemble Country Ensemble
Infinity Chorus
Acoustic/Folk Ensemble
Music History
Drum Circle
Music Business
Music Theory
Music Therapy
Sight Reading
Song Writing
Composing
Stage Set Up
Performance
Sound Technology
Stage Presence
Digital Recording
Microphone Usage
Audio Production
Music Camp
Instrument Repair
Other: ________________________________
Drawing
Graphic Art
Cartooning
Still Life
Painting
Charcoal
Portraiture
Clay / Pottery
Stop Motion Animation
Origami
Collage
Nature Art
Design Elements
Fabric Arts
Poetry
Puppet Making
Native American Art
Art Camp
Other: ________________________________
Hip Hop
Street Dance
Modern
Creative Movement
Dance Camp
Script Writing
Rock Ensemble
Hip Hop Ensemble
Art:
Dance:
Zumba
Cultural Dance
Contemporary
Other: ________________________________
Theater:
Musical Theater
Shakespeare
Set Design
Awareness Theater
Skits
Theater Camp
Das Puppenspiel Puppet Theater
Other: _______________________________
Infinity Visual and Performing Arts, Inc.  115 East Third Street  Jamestown, NY 14701  (716) 664-0991
FAX 716-664-4220  info@infinityperformingarts.org  www.infinityperformingarts.org
Explore!
Experience!
Excel!
Mission Statement
"Infinity Visual and Performing Arts, Inc. creates and sustains an environment
in which young people, based solely on their desire to participate,
can grow, learn and lead through active participation in the visual and performing arts."
Parental Involvement
This program is about music and the arts, but more importantly - your children, and their development as students and
contributors to our community. We invite you to play an active role in the development and success of Infinity and your
child's experience here. Thank you in advance for any support or help, we welcome your suggestions and comments!
Name: ________________________
Ph#: _______________Email: ___________________________
I am interested in helping with or learning more about:









CR WORD Local Music Showcase. (September 10, 2011 / September 8, 2012)
Applebee's Pancake Breakfast. (November 12, 2011)
Infinity bake sales
Infinity's Street Team! (help distribute posters, pre-sell tickets, etc.)
Infinity Arts Café counter on Café performance nights
"Project C Note" - Infinity's annual membership fundraising drive
Infinity Parental Advisory Committee
Infinity's current "Wish List"
Other ________________________________________________________
Comments/Suggestions/Ideas:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Student Opportunities
Our goal is for Infinity students to grow and progress creatively, and also as members of our community. As
Infinity grows, we are constantly developing new opportunities and experiences for our students. We
welcome suggestions and comments, please check  ideas below that interest you:
 INSTILL Program (Infinity Network of Students Training for Independent Leadership Level) - a
training program to achieve "independent" status, enabling students to utilize practice rooms,
rehearsal spaces and Infinity spaces independent of an Infinity instructor or staff member.
 Infinity Art Intern - a training program that utilizes advanced art students to assist in art classes in
return for exemption from certain art class fees. Demonstrated financial need may be a factor.
 Student Emcee - training and experience as a stage emcee and announcer for Infinity Arts Cafe and
Infinity performances.
 Student Stage Tech - a training program for mature students interested in learning and performing
stage tech duties and procedures.
 Student Sound Tech - a training program for mature students interested in learning and
participating in live sound support during Infinity Arts Cafe and other Infinity performances.
Comments/Suggestions/Ideas:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Infinity Visual and Performing Arts, Inc.  115 East Third Street  Jamestown, NY 14701  (716) 664-0991
FAX 716-664-4220  info@infinityperformingarts.org  www.infinityperformingarts.org
Explore!
Experience!
Excel!
Financial Information
 There is a non-refundable $15.00 registration fee per student due with this registration form.
Registration form and fee must be received before a student can be scheduled for lessons.

The Music program fee is $55.00 per month. Music payments are due at the first lesson of every month and must be
received by the 10th or the student may be ineligible to continue in the program. Payments can be made ahead. Families with
more than one participating music student may be eligible for a discounted rate, please call for details.

Art, Dance and Theater classes are charged on a “pay-per-class” basis.

Payments may be made by check or money order. Please do not bring in cash.

A limited number of scholarships are available for students who demonstrate financial need.
Please inquire about class prices as they vary depending on the class being offered.
(Please make checks payable to Infinity)
Infinity's Scholarship Application can be printed from our website, or requested at the Infinity Center. Completed Scholarship
Applications and the required documents must accompany registration forms for students requesting scholarships.
Registration forms cannot be processed until the Scholarship Application and documentation is submitted to Infinity.
 I have enclosed the registration fee of $15.00 by check or money order
 I understand the program fee structure and due dates
 I am submitting a scholarship application
Guardian Signature: ___________________________________________
date: _______________
(required)
Student/Guardian Commitment Contract
Please read the following agreement carefully:
1. Personal Conduct- Students must demonstrate respect for others, the equipment and facility at all times.
2. Commitment- Music students must show commitment (regular practice habits, attendance, punctuality) to their
lessons, rehearsals and performances. Guardians are responsible for encouraging and ensuring that all of these happen.
3. Permission- The guardian gives permission for the student to participate in Infinity programming and gives Infinity
permission to act on their behalf should the student require emergency medical attention while participating in a program
activity and neither the guardian nor emergency contact can be reached.
4. Evaluations- Regular evaluations of the student’s progress at Infinity will be made. Students are responsible for
providing a copy of their school report card for their portfolios each marking period.
5. Instruments and supplies- All items provided by Infinity are considered a loan to the student and are the property
of Infinity. All items are to be properly cared for and returned in good condition at the end of the student's term. If the item
is damaged, lost or stolen, it must be replaced by the guardian.
6. Photos- Infinity uses photographs taken during Infinity activities, classes and performances for advertising, funding
proposals (grants), and informational purposes. If you do not want your child to be photographed, or their name used for
these purposes, please indicate that by checking this box: 
Please sign here to indicate you understand and agree:
Guardian Signature:
______________________________________________
date: ________________
______________________________________________
date: ________________
(required)
Student Signature:
(required)
Infinity Staff Use Only
Reg. Form Review _____________ Reg. Fee ck# _____________Scholarship Form _____________ Scholarship Documents _____________ Scheduled _____________
Infinity Visual and Performing Arts, Inc.  115 East Third Street  Jamestown, NY 14701  (716) 664-0991
FAX 716-664-4220  info@infinityperformingarts.org  www.infinityperformingarts.org