1 Form Test - Spy Hop

This form should take approximately 10 minutes to complete.

Who is filling out this form?

Student Parent/Guardian on behalf of a student Other

Other

Student First Name

Student Last Name

Student Preferred Name or Nickname

Student Email

Student Mobile Phone

Home Address

City

State

ZIP Code (5 digit)

Student Birthdate (mm-dd-yyyy)

Birthday

Please describe your gender identity

Pronouns: please select any pronouns you use.

Race/Ethnicity: please select race/ethnicity

Primary Language: please select your primary language.

English Spanish

Other Languages Spoken

School (If Home School, write "Home School")

Grade: please select the student's grade.

Do you qualify for free or reduced lunch?

Yes No I don't know

How many people live in your household including yourself?

How will you typically get to Spy Hop?

Have you taken Spy Hop classes before?

Yes No

Please list the Spy Hop classes you've taken.

Do you have any allergies, dietary restrictions, or food needs you'd like us to be aware of?

Yes No

Please describe these restrictions or allergies.

Do you have any access needs, accommodations, or support preferences you'd like us to know about to help you participate fully in this program?

Yes No

If yes, please describe. While we may not be able to meet every request, we will do our best to support your participation.

Guardian/Emergency Contact First Name

Guardian/Emergency Contact Last Name

Other

Guardian/Emergency Contact Email

Guardian/Emergency Contact Phone

Additional Emergency Contact First Name

Additional Emergency Contact Last Name

Additional Emergency Contact: Please describe the relationship to the student

Additional Emergency Contact Email

Additional Emergency Contact Phone

What skills do you hope to learn in this class?

Please share how you heard about Spy Hop.

Please share at which event you heard about Spy Hop.

MUSICOLOGY: What instrument(s) do you play?

APPRENTICESHIP: Are you hoping to take this class as part of an internship requirement with your school?

Yes No

Please share your teacher or internship coordinator’s name and email address.

RESONATE: Do you have previous experience with writing lyrics/making beats/recording? If so, please share.

Would you like to receive Spy Hop emails?

Yes, please send me Spy Hop general and event updates. No

Consent to display work

I consent to my/my child’s work being displayed in the community, submitted to festivals, and other public venues.

Consent to capture likeness

I consent to Program staff photographing, videotaping, making sound recordings or screen capturing of me/my child to advertise Spy Hop programs, including public display.

Consent to data collection

I consent to Spy Hop collecting information from my child in order to evaluate its Program, including interviews, observations, surveys, and other class activities and materials. I understand that my child will complete a confidential survey about his or her attitudes and opinions as part of this evaluation. I understand that the information obtained will be analyzed and that my child’s name will be withheld for confidentiality purposes. I understand that this information will be part of a larger evaluation and only the evaluation team and program staff will have access to this confidential information.