Register Summer 2010!
Summer Registration Form
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indicates required fields
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Applicant's First Name:
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Applicant's Last Name:
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Parent or Legal Gaurdian's Name(s):
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Mailing Address (Street or PO Box):
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City:
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State:
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Zip Code:
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Home Phone:
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Work Phone:
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Cell Phone:
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E-mail address:
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Age (if minor):
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Gender:
Male
Female
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Grade in Fall '10:
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Number of classes/tuition applying for:
6 out of 10 summer classes $210.00
7 out of 10 summer classes $238.00
8 out of 10 summer classes $264.00
9 out of 10 summer classes $297.00
10 out of 11 summer classes $320.00
11 out of 11 summer classes $350
Blast off with Piano! $195.00
Blast off with Piano Jr.! $175.00
3-hr/5-day/Camp: $245
Piano for Preschoolers: $156 for 6 classes
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Regis. fee of $25 applies to all summer apps:
Private Piano
Private Voice
Private Guitar
Write your own song! (private lessons)
3-hr/5-day/Mini-Camp: 9:00-noon
3-hr/5-day/Mini-Camp: 1:00-4:00 p.m.
Piano for Preschoolers (ages 3-4 only)
Blast Off with Piano (group program)
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Please indicate the week(s) you prefer:
Week of 6/21/10
Week of 6/28/10
Week of 7/5/10
Week of 7/12/10
Week of 7/19/10
Week of 7/26/10
Week of 8/2/10
Week of 8/9/10
Week of 8/16/10
Week of 8/23/10; ___ week of 8/30
Please indicate preferred payment method:
Pay using PayPal (debit, credit, e-check); invoice will be sent via e mail
Pay by check to: Keyboard for Kids & More!, PO Box 4304, Leesburg, VA 20177
Days/times preferred if applying for private class: