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Little Mozart at Mt Pleasant
Little Mozart at CBA
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Little Mozart Summer Program

Registration Form

Child Full Name

Date of Birth

Gender

Phone

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

Yes

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

3-week

2-week (June 17th - June 28th)

2-week (June 24th - July 5th)

What instument are applying for?

Violin

Viola

Cello

Piano

Registration is completed when:

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