Youth Klezmer Band Form

MakomNY Youth Klezmer Band

Fall 2024
To register, please complete and submit this form.

Any questions? Email Audra at audraml@gmail.com
CLASS SESSIONS - Thursdays, 4:00-5:30pm at the Bethpage Worship Center
- September 12, 19, 26
- October 10, 17, 24
- November 7, 14
- December 5, 12
PERFORMANCES:
- Sunday, October 20, 1:30pm-5:00pm at a local Senior Living Residence and MakomNY Sukkot Open House
- Friday, December 20, 5:00pm-8:45pm (Musical Shabbat) at the Bethpage Worship Center (includes rehearsal, performance and dinner for band members)
Parent Name*

First NameLast Name
Parent Cell Phone*

Area CodePhone Number
Parent Email*
example@example.com
Youth 1 Name*

First NameLast Name
Youth 1 Instrument*
Youth 1 Date of Birth*

MonthDayYear
Date
Youth 1 Number of Years Playing Instrument*

1 Year2 Years3 Years4 Years5 or More Years
Youth 2 Name

First NameLast Name
Youth 2 Instrument
Youth 2 Date of Birth

MonthDayYear
Date
Youth 2 Number of Years Playing Instrument

1 Year2 Years3 Years4 Years5 or More Years
The cost is $400 per youth participating in this program. Please check the appropriate box.*

We are paying for 1 youth to participate in this program.We are paying for 2 youths to participate in this program.
If you would like to let us know anything about your child(ren), please feel free to share below. Please include any food allergies, or indicate if none. *
Payment for Teen Program

Total Payment Amount

USD.

Payment Method
Credit	Express

MakomNY Youth Klezmer Band