Student's Name:

Age (as of June 1, 2004):   Adult Infant 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Birth Date:

Parents or Guardians Names:

Siblings Names: Age:   Adult Infant 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age:   Adult Infant 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Any Special Needs?

Home Phone: Work Phone:

Email Address:

Address:

City: State: WA OR Zip:

How did you find out about us?

-------------------------------------- Camp Selection -----------------------------------------

Kindermusik: Peek-a-Boo, I Love You Zoo Train On The Road
Fairy Tale Musical Theater (3 - 5 yrs)

Piano Keyboard: Blast Off with Piano (6-8 yrs)
Blast Off with Piano (9-12 yrs)
Continuing Piano Students Level: Menehune Level 1 A Level 1 B
Private Lessons

Voice: Musical Theater: Jack and the Beanstalk (7-12 yrs)
Semi-Private Lessons
Private Lessons

----------------------------- Session / Day / Time Selection ------------------------------

If you selected a Kindermusik or a Children's Piano Keyboard camp, please check the schedule of camps and select two session / day / time combinations
(if available) that will work for you. For private or semi-private lessons, we will contact you for availability.

1st Choice Session Dates:
Day: Time:

2nd Choice Session Dates:
Day: Time:

------------------------------------- Payment Options ----------------------------------------

Camp Fees must be paid at registration. When your registration is received you will be contacted for payment arrangements using one of the following methods:

Payment in Full by Check, Debit, or Credit Card.

I agree to abide by the policies of Musical Beginnings. I am enrolling myself or my child in Summer Camp for the entire session. I understand that any materials fee is non-refundable unless Musical Beginnings is notified more than 2 weeks before the beginning of the session.