Drum Set Class Registration - Louisville Leopard Percussionists

Who: Kids in 2nd-8th grade.

When: This is an 8-month session of drum set classes for a small group of kids - September through April. Classes will be held weekly and there are multiple sessions to pick from.

Where: Leopard Rehearsal Space ~ 1404 S. Shelby St., 40217 ~ Shelby St. & Meriwether Ave.

Cost: There are three levels of monthly tuition based on your household's ability to pay: $60/$50/$40. The first month's tuition is paid upon registration. Subsequent month's tuition will be automatically charged to the same credit card for a total of 8 payments.

What: Participants will grow their skills practicing the fundamentals of how to play the drum set. They will learn how to keep a groove, how to coordinate their hands and feet, and how to play fills to popular songs throughout the decades.

How: To register, please complete the following form and make your first monthly tuition payment by credit card. If making this payment is an issue, please contact our Operations Director, Caroline Taylor: caroline@leopardmusic.org. Once you have submitted your registration, you will receive an email confirmation. If you do not receive a confirmation email, your child was not registered. Contact Caroline Taylor with questions.

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Drum Set Class Session Time*

Please select which weekly time you would like to registering your child for. Make sure their current grade matches the session you are registering them for. Max class size of 8.

Mondays @ 4:00pm (Grades 5-8) (5/8)

Fridays @ 5:00pm (Grades 5-8)

Mondays @ 5:15pm (Grades 2-5) (7/8)

Wednesdays @ 4pm (Grades 2-5)

Student Name*

First Last

Preferred Name (if different than above)

Child's Current Grade*

Child's School*

Gender*

Female

Male

Non-Binary

Other

I prefer not to say

Preferred Pronouns (optional)

She/Her

He/Him

Them/They

Other

Is your student qualified for JCPS Free/Reduce-Priced Meals?*

Yes

I don't know

Has this student enrolled in one of our programs in the past?*

Yes

Race Demographic*

This is anonymous data used for grant reporting.

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Some other race, ethnicity or origin

Ethnicity Demographic - Is your child of Hispanic, Latino/a/x, or Spanish origin?*

This is anonymous data for grant reporting.

Yes

I don't know

Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian Name*

First Last

Parent/Guardian Email*

This is where your registration confirmation will be sent.

Enter Email Confirm Email

Parent/Guardian Cell Phone*

2nd Parent/Guardian Name

First Last

2nd Parent/Guardian Email

2nd Parent/Guardian Cell Phone

Emergency Contact (Other than Parent/Guardian listed above)*

First Last Relationship Cell Phone

Comments, Questions or Special Requests:

Photo & Liability Release*

I hereby give permission for the above-named student to attend The Louisville Leopard Percussionists (LLP) camps or classes. In consideration of the advantages of LLP, I agree that the Board of Directors of LLP, its agents, and employees shall be exempt from liability for damages, for bodily injury or property damage that might occur while participating in LLP, except to the extent of insurance liability as provided by law. I understand that photos and videos are taken for publicity and distribution purposes. I hereby give my consent for any pictures in which my child appears to be used for purposes related to the promotion of LLP. I release LLP and all its members from any obligation or liability arising from use of such pictures.

I agree to this LLP photo and liability release.

Pediatrician & Medical Insurance Information

Pediatrician's Name

Pediatrician's Phone

Insurance Co.

Policy Number

Member Number

Should a medical emergency arise, we will contact you immediately. If a hospital is required, we will send all kids to Norton Children's Hospital on Chestnut Street.

Is there anything else LLP should know about your child? (severe allergies, medications, behavioral issues, special needs, etc.)

Tuition*

This registration is for an 8-month period (Sept-Apr) and is being offered on a sliding scale based on your household's ability to pay. Please select your tuition level from the three choices below. You will pay the first month's tuition today and be invoiced monthly for the next 7 payments.

Full Tuition - $60/month

Discount Tuition - $50/month

"Free & Reduced Lunch"/Low-Income Family Tuition - $40/month

Total

To finish registering, you will click the PayPal button at the end of this form. YOU DO NOT NEED A PAYPAL ACCOUNT. The next screen will give you the option of logging into PayPal or to pay by credit card underneath that and "check out as a guest." *** Please note the additional place to UNCHECK the "create PayPal account" at the very end of the process.

Payment Method*

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name