Camp Registration Form

Name Name First Last
Instrument
Age
Grade
School
Private Teacher
Teacher's Phone Teacher's Phone - ### - ### ####
Teacher's Email
Parent's Name Parent's Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent's Phone Parent's Phone - ### - ### ####
Parent's Email
Emergency Contact
Are There Food Allergies

Are There Food Allergies Yes No
List Food Allergies if applicable
Do You Play in Youth Orchestra?

Do You Play in Youth Orchestra? Yes No
Which Youth Orchestra?
Do You Currently Study Scales?

Do You Currently Study Scales? Yes No
How Many Octaves?
Are You Shifting?

Are You Shifting? Yes No
What was the Last Solo You Studied?
CANCELLATION POLICY
All cancellation requests must be received in writing by June 30, 2015. No refunds will be given on requests after this date. NO EXCEPTIONS.
There is a $50.00 cancellation fee.
There is no refund for missed classes.

I agree to this cancellation policy.

CANCELLATION POLICY
All cancellation requests must be received in writing by June 30, 2015. No refunds will be given on requests after this date. NO EXCEPTIONS.
There is a $50.00 cancellation fee.
There is no refund for missed classes.

I agree to this cancellation policy. I agree
How Would You Prefer to Pay

How Would You Prefer to Pay I'd like to pay the $395 via Paypal I'd prefer to mail my check
Paying by check?

Please send check to: 17500 Princess Anne Drive, Olney, MD 20832. Please make check payable to: Stewarts Stellar Strings.
Type the letters you see in the image below.

Camp Registration Form

Camp Registration Form

Paying by check?