SummerRegistration2019

Camper's First and Last Name *

Birthday *

Age *

Grade in Fall 2019 *

Camper's First and Last Name *

Birthday *

Age *

Grade in Fall 2019 *

Camper's First and Last Name *

Birthday *

Age *

Grade in Fall 2019 *

II. Parent or Guardian Information

Primary Contact Person First/Last Name *

Phone Number *

Email *

What are the best ways to contact you? *

Phone Call Text Email

What are the best times to contact you by phone call? *

Mom/Dad Name *

First

Last

Phone Number *

Email *

Dad/Mom Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Person *

First

Last

Emergency Contact Phone *

Where did you hear from us? *

Please choose the total number of weeks attending camp

Optional: Please indicate how many days you need early drop-off and late pick-up

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 *

Card Number *

Security Code *

Expiration Date *

I authorize Fortepiano Music Studio to charge my account

Electronic Signature of Parent or Guardian *

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

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 *

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

YOUR CART

Summer Music Camp

Summer Camp Registration Form