MUSIC DEPARTMENT CANADA TOUR 2019/APPLICATION FORM

I have read the main aspects of the Italy Tour, its goals, schedule and guidelines and express my desire
to be part of it. I also understand that SVA will inform me of the final schedule and if there is any change
to the plan. I understand that I’m responsible to pay for the Trip, and will follow SVA fundraising policy.
If, for any reason, I’m not able to participate, I understand that the deposit of the confirmation fee is not
refundable ($100).

Student Name: __________________________________________________________________

Citizenship: _____________________________________________________________________

Parent/Guardian name: ___________________________________________________________

SVA Music Ensembles you are a member of: ___________________________________________

List of allergies we need to know about: ______________________________________________

Any diet or food indications: _______________________________________________________

Any special needs or disabilities that may affect the tour: ________________________________

__________________________________ _____________________________ ____________

Student signature Parent/guardian Date

Schedule of Payment

1. At confirmation of application (September 30) $ 100.-

2. October 31 $ 360.-

3. November 30 $ 360.-

4. December 16 $ 360.-

5. January 6 $ 360.-

6. February 6 $ 360.-

TOTAL $ 1900.-