Summer CAMP Registration Form

Student Name*

First NameLast Name
Best Cell Number for Urgent Texts*
Age*
Birthday*

MonthDayYear
Date
Male/Female*
Parent Email*
example@example.com
What are your musical goals? Please list any musical background.
How did you hear about My Voice and Piano?*

Online SearchRoad SignFrom SchoolFriendOther
If a friend referred you, what is their name?
List Allergies here?
Notes section: Please describe any physical, emotional, learning, or language differences of which we should be aware in order to provide a positive learning experience. Also, please tell us your musical goals and any prior experience

To complete registration and save space for the camp you want, fill out payment portion and initial section.

If you refer 2 friends and they sign up for the exact same camp, you will get a refund for your camp the week after the camp. They must write your name on their registration form as the person that referred them.

TEXT 832-309-9033 if you have any questions
I will be using this form of payment for all payments. Choose Either Checking Account or Card of your choice and then fill out the correlating sections.*
Account Number For Checking
Routing Number For Checking
Account Number for MasterCard or Visa WITHOUT the last 4 digits
Expiration Date for MasterCard or Visa
3 digit code on the back of card for MasterCard or Visa
Name on the Account for Payment and person filling out this form*

First NameLast Name
Enter the last 4 DIGITS of the ACCOUNT you are using for payment*
ex: 1234
Billing Address for Payment*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I fully understand there may be risks associated with participation in My Voice And Piano activities. I hereby release, waive, and discharge from all liability in event of accident or injury, loss, or theft, the following parties: My Voice And Piano, owners, employees, instructors, and any other participants or venues. Studio is not responsible for students leaving premises during or after class. I grant My Voice and Piano permission to use photos, videos, audio clips, or images of my child in brochures, websites, newspapers, etc.*

I read the liability statement above and agree.
In order to prepare and hold the spot for the student, no refunds are allowed. Exchanges are allowed if notice is given 7 days prior to the start of the camp by emailing Cheryl@MyVoiceAndPiano.com. If less than 6 students sign up for a camp, the length of the camp time may be shortened. Notifications of any changes will be Texted out by the Sunday before the start of the camp. Full payment will be charged to account provided.*

I understand I will be charged for the full amount of the camp(s)/lessons selected above, there are no refunds, and camp time could be shortened if less than 6 students enroll for the same camp.
If you have a Coupon Code, Enter it here.
Thank you for filling out the registration form to get started on your musical journey!

We will be in touch with you about the schedule soon!

TEXT 832-309-9033 or EMAIL Cheryl@MyVoiceAndPiano.com with any questions you may have!
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