Intermezzo Piano Academy 2017 Registration Form
Parent/Guardian Information
Parent's Name
Your answer
Phone Number
Your answer
Cell Phone Number
Used in case of emergency
Your answer
Parent's Email
We will send you confirmation of registration via email.
Your answer
Parent Mailing Address
Your answer
Were you referred by anyone? Please specify.
Your answer
Student Information
Help us get to know your student!
Student's Name
Your answer
Student Age
Your answer
Years of Piano Study
If your student has no prior piano study please enter 'zero'.
Write the NAME and LEVEL of your students CURRENT PIANO BOOKS.
Example : Faber Piano Adventures: Level 2 *If your student is not is a method book then write in the current classical pieces they are working on. *If student has no prior training please write "none"
Your answer
Name of student's current teacher if known.
Your answer
Choose your student's T-shirt Size
Does you student have any special needs, allergies or medical conditions that the staff should be aware of?
Choose your Camp Location and Date
Choose your location
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