Bard Music Camp 2017 - Early Childhood Music

Application for Early Childhood Classes
July 3 to 8, 2017

* Indicates required field
Name Name First Last
Date Of Birth Date Of Birth / MM / DD YYYY
Gender
Grade in School (in Fall 2017)
School Name
PARENT/GUARDIAN INFORMATION
1. Name (Mr. Mrs. Dr. Ms.)
Cell Phone for Parent/Guardian #1 Cell Phone for Parent/Guardian #1 - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email for Parent/Guardian #1
Relationship to Student
2. Name (Mr. Mrs. Dr. Ms.)
Cell Phone for Parent/Guardian #2 Cell Phone for Parent/Guardian #2 - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email for Parent/Guardian #2
Relationship to Student
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency contact #1 (other than parent): Emergency contact #1 (other than parent): First Last
Emergency contact #1 phone Emergency contact #1 phone - ### - ### ####
Emergency contact #2 (other than parent): Emergency contact #2 (other than parent): First Last
Emergency contact #2 phone Emergency contact #2 phone - ### - ### ####
CAMP T-SHIRTS:
Please Indicate Student T-shirt size:

Please Indicate Student T-shirt size: 2T Kids XS 3T Kids S 4T Kids M 5T
REGISTERING FOR:
Ages 2-3: Music & Movement I - 9:00-9:45 - July 3 to 7 -- $150 Ages 4-6: Music & Movement II - 10:15-11:15 - July 3 to 7 -- $160 Ages 3 to 6: Children's Chorus - 9:45-10:15 - July 3 to 8 -- $130 Children's Chorus + Music & Movement I -- $250 Children's Chorus + Music & Movement II -- $260
DISCOUNT

DISCOUNT 10% Bard Employee Discount (applied to tuition only; not including fees)
FEES

FEES $15 Registration Fee per Family (waived for current Prep Spring 2017 students & sibling) $15 Late Fee (if Registered after June 1)
AN INVOICE AND RELEASE FORMS WILL BE EMAILED TO YOU AFTER WE RECEIVE YOUR COMPLETED REGISTRATION FORM
NOTES:

Bard Music Camp 2017 - Early Childhood Music

Bard Music Camp 2017 - Early Childhood Music

* Indicates required field

PARENT/GUARDIAN INFORMATION

CAMP T-SHIRTS:

REGISTERING FOR:

AN INVOICE AND RELEASE FORMS WILL BE EMAILED TO YOU AFTER WE RECEIVE YOUR COMPLETED REGISTRATION FORM