Lynn Kleiner's Music Rhapsody!

Register for a Camp

Child's Name:

Age: Sex: Date of birth (mm/dd/yy):

Child's Street Address:

City: State: Zip:

Child's Phone Number:

Family E-Mail:

Child's Alternate Address (if applicable):

Please take a moment to let us know how you heard about Music Rhapsody:
A Parent in the Program
Flyer
Mailing
Ad
Online Search
Free Class Coupon
Drove By Location
Other Please specify:

Camp T-Shirt Size:

Child's Grade (Fall 2013):

PARENT INFORMATION

Mother's Name:

Work Phone: Cell/Page:

Father's Name:

Work Phone: Cell/Page:

EMERGENCY INFORMATION (Must be completed!)

Comments (e.g. child's allergies, fears, etc.):

Persons Who May Be Called In An Emergency (Other than parents):
1) Name:

Relationship: Phone: Cell/Page:

2) Name:

Relationship: Phone: Cell/Page:

Emergency Waiver:

By sending this electronic form to Music Rhapsody, I, as the parent, Agency Representative, or Legal Guardian for the child designated in this form, hereby hold Music Rhapsody harmless for any and all damages, injuries or losses that may be sustained while in the care of Music Rhapsody.

MUSIC RHAPSODY CAMP TUITION POLICIES

Families with more than one child attending camp receive a 10% discount for the second child.
A $25 fee will apply to returned checks.
Tuition paid is non-refundable and cannot be applied to any other session.

GENERAL WAIVER (Must be completed!)

I have read the Music Rhapsody registration, tuition, and refund policies above on this web form, and by submitting this form, agree that I accept the registration, tuition, and refund terms stated on this Music Rhapsody form.
I also understand any photos and videos taken during classes may be used by Music Rhapsody for educational or advertising and promotional purposes.

Agree to Waiver *:

Name of Parent or Responsible Party *:

Email Address *: Date (mm/dd/yy):

You probably know a parent or school that would love to hear about Music Rhapsody. Please enter one or more contact names with contact information below, and we'll let them know about our fun and educational music programs!

Name:

Phone Number or Email Address:

THANKS! PLEASE CAREFULLY REVIEW FORM BEFORE SUBMITTING.

After completing the registration form, click on the Submit button. You will be returned to your class page to enter class in Shopping Cart.