Student's Name
*
First Name
Last Name
Student's Birthday
*
-
Year
-
Month
Day
Date
Parent/Guardian's Name
*
First Name
Last Name
Parent/Guardian's Email
*
example@example.com
Parent/Guardian's Phone Number
*
Please enter a valid phone number.
Please Enter your Address Below:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What grade will your child be in as of September 2025?
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Other
Does your child play a musical instrument?
*
Does your child have a friend in the program that you would like for them to be in the same group with?
*
Please list the name of an Emergency Contact
*
First Name
Last Name
Please list your Emergency Contact's Relationship to the Student
*
Emergency Contact's Phone Number
*
Please enter a valid phone number.
When was your child's last tetanus shot? (Month/Year)
*
Does your participant have any special circumstances, medical concerns/limitations, or allergies that we need to be aware of?
*
Yes
No
If yes, please describe below. If no, leave blank.
How did you hear about the Summer Music Explorers Program?
Please Acknowledge the Statements Below
*
I agree to send my child's doctor signed physical by May 1, 2025.
I acknowledge ANMS may take photographs/video of my child.
Tuition is $1,875 for the program.
*
I am a current ANMS student: Please charge my card on file
Please call me to discuss a payment method
Interested in Additional Programming?
*
Yes, I am interested in 8:00 AM Early Drop Off. This will add an additional $400 to enrollment.
(WAITLIST ONLY) Yes, I am interested in the Summer Melodies: Piano Lab and Ukulele camp day extension program taught by Miss Kim Petot: Tuesdays, Wednesdays, and Thursdays extending the camp day until 4:30 PM. This will add an additional $450 to enrollment.
No thank you, not right now.
Maybe, please send me more information.
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