Easton Music Academy Summer Camp Registration

Summer Camp Registration
Students Name

First NameLast Name
Student's Birthdate

MonthDayYear
Date
Parents Name

First NameLast Name
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Medical Conditions / Food Allergies
Emergency Contact Name, Relationship and Phone

Fine Arts Camp$250.00

Uke Camp$200.00

Star Strummers$200.00

Keyboard Kamp$200.00

Music Makers$220.00

Enter coupon

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

You will receive an email or text from us confirming your childs registration :)
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