2017 Peaks to Plains Suzuki Institute Student Registration Form
Fill out this form if your student is a PreTwinkler, Book 1+ or a sibling. Advanced String Camp and Teacher Trainers have a different form. Please see the "Advanced String Camp" Registration or "Teacher Training" Registration Forms.
Student First Name *
Your answer
Student Last Name *
Your answer
Student Address (Street) *
Your answer
Student Address (City) *
Your answer
Student Address (State) *
Your answer
Student Address (Zip) *
Your answer
Student's age on 7-14-2017 *
Your answer
Gender *
Required
Instrument *
Required
Parent's Name
Your answer
Parent's email address
Your answer
Parent's phone number
Your answer
CURRENT Suzuki Book number and CURRENT working piece name *
Book level and name of child's current (at the time of registration) latest memorized piece is very important and will be used to properly place your child.
Your answer
Suzuki teacher's name
Your answer
Teacher's email address
Your answer
First enrichment choice
If your child is registering as Book 1 + student, music theory will automatically be part of their core classes. Tuition includes 5 classes (up to 3 enrichments, depending on child's level and instrument)
Second enrichment choice
If your child is registering as Book 1 + student, music theory will automatically be part of their core classes. Tuition includes 5 classes (up to 3 enrichments, depending on child's level and instrument)
Third enrichment choice
If your child is registering as Book 1 + student, music theory will automatically be part of their core classes. Tuition includes 5 classes (up to 3 enrichments, depending on child's level and instrument)
Fourth enrichment choice
If your child is registering as Book 1 + student, music theory will automatically be part of their core classes. Tuition includes 5 classes (up to 3 enrichments, depending on child's level and instrument)
Registration Fee *
Required for all participants, non-refundable, waived if pre-registered in 2016.
Tuition Fees + Extras *
Required
Institute T-Shirt
optional, $15.00 per t-shirt. Use"other" box if want more than one in the same size.
Lunches (Monday through Friday) - menu at ppsicolorado.com
Optional, must be pre-ordered. Child: $40.00/week, Adult: $45.00/week. Indicate number of child or adult lunches plus regular or vegetarian. ie. 1 child regular and 2 adult vegetarian
Your answer
Donation to the Scholarship fund (optional)
indicate dollar amount
Your answer
Deposit Paid in 2016 *
If you paid a deposit last year, the registration fee is waived if you register before 5/7 and subtract $50 off your total.
TOTAL AMOUNT DUE *
Registration fee + tuition + extras + t-shirt + lunches + donation - last year deposit. Remember to subtract $50.00 if you pre-registered and paid a deposit last year. **REMEMBER YOUR TOTAL! AFTER CLICKING SUBMIT, PAY BELOW WITH PAYPAL OR MAIL A CHECK**
Your answer
Signature acknowledging PARTICIPANT WAIVER *
Please read the Participant Waiver (http://www.ppsicolorado.com/ppsi_ParticipantWaiver.pdf) Type your name below as your signature.
Your answer
Submit
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