Summer Music Program Enrollment Form

Summer Music Program - Enrollment Form
Thank you for your interest in SMP. The 2022 SMP program will run from Monday, July 18 through Saturday, July 23. Program hours will be from 10AM-3PM, located at the VYCo space.
STUDENT INFORMATION:
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Level
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Is this phone number SMS-enabled?
E-mail *
example@example.com
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Is Emergency Contact phone number SMS-enabled?
Emergency Contact E-mail *
example@example.com
MEDICAL INFORMATION
Does the student have any food allergies/restrictions? *
Does the Student have any medical/health/behavioral conditions SMP should know about? *
SMP Program hours will have classes running from 10:00AM – 3:00PM. Drop off will begin at 9:30AM and Pick up will end at 4:30PM. Does your family need additional time outside of this timeframe to drop off and pick up? We will do our very best to accommodate. *
Does SMP have permission to use video clips/photos taken during program as part of their marketing materials? Materials may contain images of your Student. Y/N *
Tuition deposit ($150) for SMP is due June 20, 2022. The full tuition cost ($520) is due July 1, 2022. My payment method for the deposit will be

Check (to Village Youth Conservatory) Venmo (@VillageYouthConservatory) PayPal (@VillageYouthCo)
Should be Empty:

Summer Music Program - Enrollment Form

STUDENT INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION