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About
Our Story
Our Teachers
Facility Rental
Music Lessons
Online Music Lessons
In-Person Lessons
Preschool Piano and Singing
K-12 Lessons
Adult Music Lessons
Schedule Appointment
Register
Contact Us
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YOUR CART
Summer Music Camp
Registration Form Below
Summer Camp Registration Form
I. Student Information
Please fill out names for 1, 2, or 3 students
*
Indicates required field
Camper's First and Last Name
*
Birthday
*
Age
*
Grade in Fall 2019
*
School
*
List any medical conditions, allergies, etc.
*
Camper's First and Last Name
*
Birthday
*
Age
*
Grade in Fall 2019
*
School
*
List any medical conditions, allergies, etc.
*
Camper's First and Last Name
*
Birthday
*
Age
*
Grade in Fall 2019
*
School
*
List any medical conditions, allergies, etc.
*
II. Parent or Guardian Information
Primary Contact Person First/Last Name
*
Phone Number
*
Email
*
Please provide an email you check regularly
What are the best ways to contact you?
*
Phone Call
Text
Email
What are the best times to contact you by phone call?
*
Examples: After 4pm, Between 9am-12pm, etc.
Mom/Dad Name
*
First
Last
Phone Number
*
Email
*
Please provide an email you check regularly
Dad/Mom Name
*
First
Last
Phone Number
*
Email
*
Please provide an email you check regularly
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact Person
*
First
Last
Emergency Contact Phone
*
Where did you hear from us?
*
III. Camp Weeks
Please choose dates attending camp
*
Week 1: June 10-14
Week 2: June 17-21
Week 3: June 24-28
Week 4: July 1-5
Week 5: July 8-12
Week 6: July 15-19
Week 7: July 22-26
Week 8: July 29-August 2
Week 9: August 5-9
Please choose the total number of weeks attending camp
One Camper
*
1 week: $150
2 weeks: $300
3 weeks: $450
4 weeks: $600
5 weeks: $750
6 weeks: $900
7 weeks: $1,050
8 weeks: $1,200
9 weeks: $1,350
Two Campers
*
1 week: $290
2 weeks: $580
3 weeks: $870
4 weeks: $1,160
5 weeks: $1,450
6 weeks: $1,740
7 weeks: $2,030
8 weeks: $2,320
9 weeks: $2,610
Three Campers
*
1 week: $430
2 weeks: $860
3 weeks: $1,290
4 weeks: $1,720
5 weeks: $2,150
6 weeks: $3,010
7 weeks: $3,440
8 weeks: $3,870
9 weeks: $4,300
Optional: Please
indicate how many days you need early drop-off and late pick-up
Before care is 8:30am-9:30am
Before care days and options
*
None, I will drop off my kids at 9:30am
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
After care is 3:00pm-4:30pm
After care days and options
*
None, I will pick up my kids on time at 3:00pm
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
IV. Method of Payment
Please select one of the following payment methods below:
First Option: Best
To help save you time and energy, we encourage you to set up automatic credit card/debit card recurring billing for music lessons. This will save you considerable time because the same amount will be charged to your credit/debit card and never have to think of it again! Plus your payment will always be on time.
Automatic Recurring Billing
*
Credit Card/Debit Card
Use Card Already On File
Cardholder's Name
*
Type
*
Visa
Mastercard
American Express
Discover
Card Number
*
Security Code
*
Expiration Date
*
I authorize Fortepiano Music Studio to charge my account
Electronic Signature of Parent or Guardian
*
Please type your name in the field below. This will be your electronic signature
Date
*
Second Option: Good
Paypal Invoice
An invoice will be sent by text or email. Payment may be done online or in-person by credit card, check, or cash
Paypal Invoice
*
Paypal Invoice
A 50% deposit of the total amount is due upon registration to reserve your spot. The remaining balance is due 7 days before the week your child is attending camp. Once payment is received, your spot is reserved.
V. Studio Adherence Statement
Your electronic signature indicates your understanding of the guidelines of the Fortepiano Music Studio Guidelines pertaining to Fortepiano Music Studio and agree to abide by their stipulations. Please read
Fortepiano Music Studio Summer Camp Guidelines
found below.
Please Select
*
I have read Fortepiano Music Studio Summer Camp Guidelines
Electronic Signature of Parent or Guardian
*
Please type your name in the field below. This will be your electronic signature.
Date
*
VI. Media Release Consent
Occasionally, photos or video of students are taken during camp for use in studio newsletters, studio social media, advertising materials, lessons demonstrations, and studio owned websites.
Please Check One
*
YES, the Studio may use recordings & images of my child in the manner described above
NO, the Studio may not use any recordings or images of my child in the manner described above
Electronic Signature of Parent or Guardian
*
Date
*
Submit