Registration Form

Bach 2 Basics Time Travelers Summer Camp 2012 Registration Form

Child's First Name:
Child's Last Name:
Current Age:
Child's Musical Experience (is he/she taking music lessons, for how long, etc):


On which intrument would you like your child to recieve private intructions?
piano
violin (violinists will be required to bring their own violin)
piano and violin

What would you like to see your child take away from this camp?:

Does your child have any allergies?

If yes, please list and briefly describe them here:

Does your child have any medical condition or injuries that will restrict or prevent him / her from participation in physical activites?
If yes, please list and briefly describe them here:

Full name of primary legal guardian (to be called first in case of emegency):
Preferred Email Address:
Preferred Phone Number:
Full name of primary legal guardian (to be called second in case of emegency):
Preferred Email Address:
Preferred Phone Number: