Summer Camp Registration

Summer Camp Registration

Please complete the form below to register your child for summer camp.
Student Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Emergency Contact Name (Must be different from parent/guardian above)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Camp Selection

Please make your camp selection and payment below.

Camps*

Rochester Summer Camps

Rock Band Camp (Lake Orion)

JULY 20-24 - 9am-4:30pm (before/aftercare available, please ask): *Note* This camp takes place off campus at 550 E. Silverbell Road, Lake Orion. Ages 6-12.

$499.00 Quantity

Pop Piano Camp (Rochester)

JULY 27-31 - 1-4:30 Daily (can be taken with Singer Songwriter for full day option). Ages 6-12.

$309.00 Quantity

Singer Songwriter Camp (Rochester)

JULY 27-31 - 9am-12:30 Daily (can be taken with Pop Piano for full day option). Ages 6-12.

$309.00 Quantity

Bluey Piano Camp (Rochester)

AUGUST 3-7 - 9-11:30am - Ages 3-6. *Students must be bathroom independent to enroll*

$219.00

Music Safari Camp (Rochester)

AUG. 10-14 - 9-11:30am Ages 3-6 *Students must be bathroom independent to enroll*

$219.00

Oxford Summer Camps

Music Safari Camp (Oxford)

AUG. 3-7 - 9-11:30am Ages 3-6 *Students must be bathroom independent to enroll*

$219.00

Pop Piano Camp (Oxford)

AUGUST 10-15 - 1-4:30pm - Ages 6-12 (can be taken with Singer Songwriter from 9-12:30 for full day camp)

$309.00 Quantity

Singer Songwriter Camp (Oxford)

AUGUST 10-15 - 9-12:30 - Ages 6-12 (can be taken with Pop Piano camp from 1-4:30pm)

$309.00 Quantity

Bluey Piano Camp (Oxford)

JULY 27-31 - 9-11:30am - Ages 3-6. *Students must be bathroom independent to enroll*

$219.00

Royal Oak Summer Camps

Singer Songwriter Camp (Royal Oak)

AUGUST 3-7 - 9-12:30 - Ages 6-12 (can be taken with Pop Piano camp from 1-4:30pm)

$309.00 Quantity

Music Safari Camp (Royal Oak)

JULY 27-31 - 9-11:30am - Ages 3-6 *Students must be bathroom independent to enroll*

$219.00

Pop Piano Camp (Royal Oak)

AUGUST 3-7 - 1-4:30 Daily (can be taken with Singer Songwriter for full day option). Ages 6-12.

$309.00 Quantity

Bluey Piano Camp (Royal Oak)

AUGUST 10-15 - 9-11:30am - Ages 3-6. *Students must be bathroom independent to enroll*

$219.00

Enter coupon

Total

$0.00

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

Student Information
Does your child have any allergies?
If yes, please explain:
Does your child have any medical, emotional, or behavioral conditions we should be aware of?
If yes, please explain:

Other
Does your child take any medication that will need to be taken during camp? (please note, if yes, a separate medication informations form will need to be submitted).
Please list the names of those who have permission to pick your camper up from camp, and their relationship to your camper:*

I understand that photos and videos may be taken during camp activities, and I give permission for my child to be included in studio photos and videos used for promotional purposes.*
Signature

I certify that the information provided above is accurate to the best of my knowledge. I understand that participation involves inherent risks, and I agree to hold harmless Red Piano Music Studio, its staff, volunteers, and employees from liability for injuries that may occur. I also understand that no refunds will be issued within 10 days of the camp start date.
Signature*
Should be Empty:

Summer Camp Registration

Camp Selection

Student Information

Signature