Name *

First Name

Last Name

Phone

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Check if Interested:

Vocal

All students will participate in the dance class *

I Agree

Name *

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone *

(###)

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Emergency Contact

First Name

Last Name

Phone

(###)

###

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I hereby agree that the B-Sharp Summer Music Academy personnel may administer First Aid in case of emergency and /or refer participant to a local clinic or hospital for treatment. I understand that participants are not to bring any medications to camp without prior approval. *

I Agree

I agree to abide by rules and regulations of the B-Sharp Summer Music Academy. I agree to hold the Academy, its employees, officials and staff harmless from any and all claims for damages unless due to the sole negligence of the employees or agents.

I Agree