Vienna Strings Enrollment Form

Participant Name::

Age this summer::

Parent's Full Name::

Street Address::

City/State/Zipcode::

Home Phone::

This application has my approval and consent: (enter your full name):

Please include my name in a car pool list to b distributed via email prior to June 30::
yes
no

Each participant will receive a T-Shirt to be worn for the concert. :
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large (14-16)
Child Medium (10-12)

Instrument::

School Attending::

Grade Completed::

School String Teacher::

Private String Teacher::

Years of Experience::

Method Books Used::

Orchestra experience outside of school::

Name of Parent/Guardian available during the day::

Parent/Guardian Phone Numbers (Home)::

Parent/Guardian Phone Numbers (Work)::

Parent/Guardian Phone Numbers (Cell)::

Emergency Contact Name::

Emergency Contact Telephone::

Parent Email::

Program Desired::
Beginning Program ($230 before 6/14 or $255 after)
Regular Program ($230 before 6/14 or $255 after)

Sibling Discount:
This registration qualifies for the 10% Sibling Discount

Method of Payment:*
Check or money order sent via postal mail
PayPal

Comments to the Registrar::

Please type the text below: