2021 SLIA Summer Camp Registration
In-Person at Immaculate Conception School 7240 Anna Ave Maplewood MO 63143
Family Last Name
*
Last Name
How did you find our camp?
*
Please Select
Current SLIA Family - yey!
Friends are Current SLIA Members
SLIA Family Members
My music teacher recommended SLIA
Friends with/student of a SLIA instructor
SLIA Website
SLIA Facebook Page
SLIA Performance
Social Media/Online
Other
Parent #1 Name
*
First Name
Last Name
Parent #1 Email
*
This will be the main email address we will include on the 2021 SLIA Summer Camp information email list.
Parent #1 Phone Number
*
This will be the main parent contact number we will associate with all the students in your family.
Family Mailing Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Parent #2 Name
First Name
Last Name
Parent #2 Email
If provided, we will include this email address on the 2021 SLIA Summer Camp information email list in addition to the required email address included above.
Parent #2 Phone Number
This will be the 2nd parent contact number we will associate with all the students in your family if we cannot reach Parent #1 in an emergency.
Parent #2 Mailing Address
Street Address
Street Address Line 2
City
State
Zip Code
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Student #1 Name
*
First Name
Last Name
Birthday #1
*
-
Month
-
Day
Year
Date
Today
-
Month
-
Day
Year
Date
Bday1 calc
Calculation
Age
School Grade in Fall 2021
*
Please Select
Preschool
Pre-Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade (Freshman)
10th Grade - (Soph)
11th Grade - (Jr)
12th Grade - (Sr)
List any allergies, required emergency medications you will be supplying, health restrictions, or other important medical info:
WEEK 1: June 14th-18th
SLIA Irish Music Camp Week / $125
*
9:30am-12:15pm (ages 7-11yrs)
1pm-3:30pm (ages 12-17yrs)
Not attending Week 1 Music Camp
Student's main instrument?
Please Select
Tin Whistle
Fiddle
Flute
Concertina
Piano Accordion
Harp
Banjo
Piano
SLIA music student?
Please Select
Yes, attended SLIA virtually in 2020/21
Yes, but took a break during 2020/21
Never attended SLIA classes, but I have taken music lessons on my instrument.
Where do you take music lessons?
“5-Day Try” New Instrument / $50
*
9am-9:30am (ages 7-11yrs)
3:30pm-4pm (ages 12-17yrs)
Not attending Week 1 New Instrument
Which New Instrument?
harp
concertina
piano accordion
flute
fiddle
banjo
WEEK 2: June 21st - 25th
SLIA Irish Dance Camp Week / $125
*
9am-12:30pm (ages 7-17yrs)
Not attending Week 2 Dance Camp
SLIA dance student?
Please Select
Yes, attended SLIA virtually in 2020/21
Yes, but took a break during 2020/21
New to SLIA, but former student at a different Irish dance school.
New to SLIA, current student at another Irish dance school
New to SLIA, but have taken dance lessons (ballet, jazz, modern, tap, etc)
Where did / do you take lessons?
Do you have approval to attend from your TCRG?
“5-Day Try” New Instrument / $50
*
1pm-1:30pm (ages 7-17yrs)
Not attending Week 2 New Instrument
Which New Instrument?
harp
concertina
piano accordion
flute
fiddle
banjo
continuing from Week 1
WEEK 3: June 28th - July 2nd
SLIA Beginner Camp / $150
*
(ages 4-17yrs) 9:30am-12:15pm
Not attending Week 3 Beginner Camp
Student #1 Tuition Total:
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Student #2 Name
First Name
Last Name
Student #2 Registration
Birthday #2
*
-
Month
-
Day
Year
Date
Bday2 calc
Today
-
Month
-
Day
Year
Date
Calculation
Age
School Grade in Fall 2021
*
Please Select
Preschool
Pre-Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade (Freshman)
10th Grade - (Soph)
11th Grade - (Jr)
12th Grade - (Sr)
List any allergies, required emergency medications you will be supplying, health restrictions, or other important medical info:
WEEK 1: June 14th-18th
SLIA Irish Music Camp Week / $125
*
9:30am-12:15pm (ages 7-11yrs)
1pm-3:30pm (ages 12-17yrs)
Not attending Week 1 Music Camp
Student's main instrument?
Please Select
Tin Whistle
Fiddle
Flute
Concertina
Piano Accordion
Harp
Banjo
Piano
SLIA music student?
Please Select
Yes, attended SLIA virtually in 2020/21
Yes, but took a break during 2020/21
Never attended SLIA classes, but I have taken music lessons on my instrument.
Where do you take music lessons?
“5-Day Try” New Instrument / $50
*
9am-9:30am (ages 7-11yrs)
3:30pm-4pm (ages 12-17yrs)
Not attending Week 1 New Instrument
Which New Instrument?
harp
concertina
piano accordion
flute
fiddle
banjo
WEEK 2: June 21st - 25th
SLIA Irish Dance Camp Week / $125
*
9am-12:30pm (ages 7-17yrs)
Not attending Week 2 Dance Camp
SLIA dance student?
Please Select
Yes, attended SLIA virtually in 2020/21
Yes, but took a break during 2020/21
New to SLIA, but former student at a different Irish dance school.
New to SLIA, current student at another Irish dance school
New to SLIA, but have taken dance lessons (ballet, jazz, modern, tap, etc)
Where did / do you take lessons?
Do you have approval to attend from your TCRG?
“5-Day Try” New Instrument / $50
*
1pm-1:30pm (ages 7-17yrs)
Not attending Week 2 New Instrument
Which New Instrument?
harp
concertina
piano accordion
flute
fiddle
banjo
continuing from Week 1
WEEK 3: June 28th - July 2nd
SLIA Beginner Camp / $150
*
(ages 4-17yrs) 9:30am-12:15pm
Not attending Week 3 Beginner Camp
Student #2 Tuition Total:
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Student #3 Name
First Name
Last Name
Student #3 Registration
Birthday
*
-
Month
-
Day
Year
Date
Today
-
Month
-
Day
Year
Date
Bday3 calc
Calculation
Age
School Grade in Fall 2021
*
Please Select
Preschool
Pre-Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade (Freshman)
10th Grade - (Soph)
11th Grade - (Jr)
12th Grade - (Sr)
List any allergies, required emergency medications you will be supplying, health restrictions, or other important medical info:
WEEK 1: June 14th-18th
SLIA Irish Music Camp Week / $125
*
9:30am-12:15pm (ages 7-11yrs)
1pm-3:30pm (ages 12-17yrs)
Not attending Week 1 Music Camp
Student's main instrument?
Please Select
Tin Whistle
Fiddle
Flute
Concertina
Piano Accordion
Harp
Banjo
Piano
SLIA music student?
Please Select
Yes, attended SLIA virtually in 2020/21
Yes, but took a break during 2020/21
Never attended SLIA classes, but I have taken music lessons on my instrument.
Where do you take music lessons?
“5-Day Try” New Instrument / $50
*
9am-9:30am (ages 7-11yrs)
3:30pm-4pm (ages 12-17yrs)
Not attending Week 1 New Instrument
Which New Instrument?
harp
concertina
piano accordion
flute
fiddle
banjo
WEEK 2: June 21st - 25th
SLIA Irish Dance Camp Week / $125
*
9am-12:30pm (ages 7-17yrs)
Not attending Week 2 Dance Camp
SLIA dance student?
Please Select
Yes, attended SLIA virtually in 2020/21
Yes, but took a break during 2020/21
New to SLIA, but former student at a different Irish dance school.
New to SLIA, current student at another Irish dance school
New to SLIA, but have taken dance lessons (ballet, jazz, modern, tap, etc)
Where did / do you take lessons?
Do you have approval to attend from your TCRG?
“5-Day Try” New Instrument / $50
*
1pm-1:30pm (ages 7-17yrs)
Not attending Week 2 New Instrument
Which New Instrument?
harp
concertina
piano accordion
flute
fiddle
banjo
continuing from Week 1
WEEK 3: June 28th - July 2nd
SLIA Beginner Camp / $150
*
(ages 4-17yrs) 9:30am-12:15pm
Not attending Week 3 Beginner Camp
Student #3 Tuition Total:
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Student #4 Name
First Name
Last Name
Student #4 Registration
Birthday
*
-
Month
-
Day
Year
Date
Today
-
Month
-
Day
Year
Date Picker Icon
Bday4 calc
Calculation
Age
School Grade in Fall 2021
*
Please Select
Preschool
Pre-Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade (Freshman)
10th Grade - (Soph)
11th Grade - (Jr)
12th Grade - (Sr)
List any allergies, required emergency medications you will be supplying, health restrictions, or other important medical info:
WEEK 1: June 14th-18th
SLIA Irish Music Camp Week / $125
*
9:30am-12:15pm (ages 7-11yrs)
1pm-3:30pm (ages 12-17yrs)
Not attending Week 1 Music Camp
Student's main instrument?
Please Select
Tin Whistle
Fiddle
Flute
Concertina
Piano Accordion
Harp
Banjo
Piano
SLIA music student?
Please Select
Yes, attended SLIA virtually in 2020/21
Yes, but took a break during 2020/21
Never attended SLIA classes, but I have taken music lessons on my instrument.
Where do you take music lessons?
“5-Day Try” New Instrument / $50
*
9am-9:30am (ages 7-11yrs)
3:30pm-4pm (ages 12-17yrs)
Not attending Week 1 New Instrument
Which New Instrument?
harp
concertina
piano accordion
flute
fiddle
banjo
WEEK 2: June 21st - 25th
SLIA Irish Dance Camp Week / $125
*
9am-12:30pm (ages 7-17yrs)
Not attending Week 2 Dance Camp
SLIA dance student?
Please Select
Yes, attended SLIA virtually in 2020/21
Yes, but took a break during 2020/21
New to SLIA, but former student at a different Irish dance school.
New to SLIA, current student at another Irish dance school
New to SLIA, but have taken dance lessons (ballet, jazz, modern, tap, etc)
Where did / do you take lessons?
Do you have approval to attend from your TCRG?
“5-Day Try” New Instrument / $50
*
1pm-1:30pm (ages 7-17yrs)
Not attending Week 2 New Instrument
Which New Instrument?
harp
concertina
piano accordion
flute
fiddle
banjo
continuing from Week 1
WEEK 3: June 28th - July 2nd
SLIA Beginner Camp / $150
*
(ages 4-17yrs) 9:30am-12:15pm
Not attending Week 3 Beginner Camp
Student #4 Tuition Total:
Student #4 Registration
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Please Read, Click The Boxes To Agree, and Sign Below to Complete Your Registration.
Parent Signature
*
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2021 SLIA Summer Camp Emergency Contact Information
Emergency Contact #1: Full Name
*
This can be another SLIA parent, grandparent, older silbing, other family member, babysitter, neighbor, nanny, neighbor, etc.
Relationship
#1 Cell Phone Number
*
-
Area Code
Phone Number
Emergency Contact #2: Full Name
*
This can be another person that we should be aware of: older sibling, carpool SLIA parent, grandparent, nanny, babysitter, neighbor, etc
Relationship
#2 Cell Phone Number
*
-
Area Code
Phone Number
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2021 SLIA Summer Camp Registration Summary
Student #1: {student1}
$ {student1142}
Student #2: {student2}
$ {student2165}
Student #3: {student3}
$ {student3187}
Student #4: {student4}
$ {student4210}
Total Tuition Due:
$ {totalTuition238}
2021 SLIA Summer Camp Registration Payment Details
Total Tuition Due:
Total:
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