Littleton School of Music Summer Camp 2019 - Registration Form
JULY 8 - JULY 13 (9 AM - 3 PM Daily)
Email address *
Parent/Guardian name *
First and last
Parent/Guardian address *
Please enter full address, city, state and zip code
Parent/Guardian email *
*by entering email address you agree to subscribe to our email newsletter*
Parent/Guardian phone *
Alternate phone
Where did you hear about us?
Clear selection
Musician's name *
first and last
Musician's address
If different from Parent/Guardian
Musician's birthdate *
MM
/
DD
/
YYYY
Musician's gender *
Musician's playing experience *
Musician's t-shirt size *
Is your musician coming to camp with another friend they want to play with? If so please list here.
There are no guarantees your musician will play with their requested band members.
Emergency contact number *
Are there any existing medical conditions we should be aware of?
There will be a field trip that requires an additional safety waiver. Are you willing to sign this and return in a separate email? (This field trip, lunch, and refreshments is INCLUDED in the cost of your camp registration). *
Filling out this waiver is a requirement to complete registration.
If you are NOT able to drive your own child or teen to and from the location on field trip day, are you willing to sign a liability waiver for another parent or instructor to provide this transportation? *
You can opt to take your child home for this portion of the day, however no discount will be provided.
Are you willing to be an authorized "chaperone" and drive students to and from the field trip? *
If so, how many children/teens could safely ride with you in your vehicle?
Do you want to pay the FULL DISCOUNT rate of $399.99 or make (2) PAYMENTS of $214.99? You will be sent an invoice to pay using PayPal upon completion of registration. *
Parent/Guardian Electronic Signature *
by signing this form you agree to our Terms of Agreement: I understand that Littleton School of Music is a substance free organization. All campers and staff members will refrain from any foul language, reckless behavior, cigarette smoking or other tobacco use, alcohol consumption, marijuana use, or the taking of any illegal drugs, while participating in any Littleton School of Music activity and while on the Littleton School of Music premises. Theft and vandalism of Littleton School of Music property or the property of others is prohibited. Any violation of these rules and policies will result in immediate dismissal from Littleton School of Music. I also grant Littleton School of Music the permission to use any photographs, video, or film image of my child for the promotion of Littleton School of Music. No refunds of any kind will be issued.
A copy of your responses will be emailed to the address you provided.
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