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Little Mozart at Mt Pleasant
Little Mozart at CBA
Why Music
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Schedule
Little Mozart Summer Program
Registration Form
Child Full Name
Date of Birth
Gender
Phone
Email
Street Address
City
State
Parent(s) or Guardian's full name, (if guardian, please write the relationship to the child)
Please, list the names of the two persons in the local area who will accept responsability for the care of your child if you cannot be reached
Throughout the Summer Program, we take children's pictures and videos. We would like to use some of these pictures or videos on our school's website, brochure and school social media pages. Please indicate your permission to put your child's pictures
*
Required
Yes
No
Pick up Policy - Only Mom or Dad, or the pleople listed above as having parental permission, will be allowed to pick up your child. Any other arrangement, either temporary or permanent, must be given in writing. In case of a last minute emergency, parent must call the CBA office, an the message will be relayed to your child's teacher. A picture ID is required for anyone other than a parent.
Select number of weeks
*
Required
3-week
2-week (June 17th - June 28th)
2-week (June 24th - July 5th)
What instument are applying for?
*
Required
Violin
Viola
Cello
Piano
Registration is completed when:
*
Required
Application is signed (Print your name in the space below)
You understand that your child needs to practice at home the recommended time his/her teacher requests
Signature (Your signature legally confirms that all of the information you have provided is accurate
Submitt
Thanks for submitting!
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