Westminster Conservatory 2014 Instrumental Summer Camps
Fill out one Registration form per student.

NOTE: Items marked * are required.




Applicant Information
 * Last Name of Student:
 * First Name of Student:
 * Birth Date (month/day/year):
 * Grade as of Sept. 2014:
 * Age as of July 1, 2014:
 * Student is a: Returning Student    New Student   
If a new student, where did you hear about our summer camps?
 * Student is: Male    Female   
 * T-Shirt Size: Youth XS (2-4) Youth S  Youth M  Youth L
Adult S  Adult M  Adult L  Adult XL
Registration Information
 *Check off the camps for which 
the student is registering:
Piano Camp Week 1: Duets and Jazz (Grades 3-8) (July 7 - 11)
Piano Camp Week 2: Solos and Jazz (Grades 3-8) (July 14 - 18)
Piano Camp Week 3: Duets and Art (Grades 3-8) (July 21 - 25)
Summer Orchestra Week (Grades 4-6) (August 18 - 22)
Summer Band Week (Grades 4-6) (August 18 - 22)
Flute Camp Day Student (Grades 6-12) (July 27 - August 2)
Flute Camp Residential Student (Grades 6-12) (July 27 - August 2)
Westminster Chamber Music Camp (Grades 6-12) (June 28 - July 2)
Chamber Ensemble Camp (Grades 7-12) (July 7 - 11)
Jazz Starters Camp (Grades 5-8) (June 30 - July 4)
Jazz Combo Boot Camp (Grades 8-12) (August 4 - 8)
 * Instrument:
 * Number of Years of Study:
Name of Private Teacher, if any:
Email or phone number of private teacher, if any:
Name of School:
School Music Teacher, if any:
Please email (wccConserv@rider.edu) or fax (609-921-7296) a list of your repertoire to Westminster Conservatory. Make sure it includes your name and the name of your camp.
Refer a Friend Progam (For all camps except Westminster Chamber Music Camp)
Did someone refer you to this camp as part of the 
"Refer a Friend Program"?:
Yes    No   
If yes, Name of referring friend:
Name of Parent or Guardian of referring friend:
I understand that under the "Refer a Friend Program", submission of the name of the referring friend will entitle them to a discount towards their camp tuition if I sign up for the same camp. I also understand that if two students sign up for the same camp, they cannot use the "Refer a Friend Program" to refer each other. Yes   
Contact Information
 * Home Address 1:
Home Address 2:
 * City:
 * State:
Province/Region: (If State is "Other")
 * Zip/Postal Code:
 * Country:
 * Home Phone of student (w/ area code): ()
Father/Guardian Name:
Father/Guardian Work Phone (w/ area code): ()
Father/Guardian Cell Phone (w/ area code): ()
Father/Guardian Email Address:
Mother/Guardian Name:
Mother/Guardian Work Phone (w/ area code): ()
Mother/Guardian Cell Phone (w/ area code): ()
Mother/Guardian Email Address:
 * Name of Emergency Contact:
 * Phone Number of Emergency Contact (w/ area code): ()
Billing Information
 * Send Bill To: Mr.    Mrs.    Ms.    Dr.   
 * Name:
 * E-Mail Address:
 * Is Billing Address the same as Student Home Address listed above? Yes     No     (If "No", please specify below.)
Billing Address 1:
Billing Address 2:
City:
State:
Province/Region: (If not from US)
Zip/Postal Code:
Country:
Payment Information
* Please read the conditions of registration and  check the box indicating that you accept them. 
A non-refundable camp deposit of $100 must accompany this form. If registering after June 1, full payment must be made.

NOTE:
 Refunds, credits, or make-ups cannot be given for camp days missed by the student. Westminster Conservatory reserves the right to cancel a camp up to two weeks prior to the starting date due to insufficient enrollment. Families affected will receive a full refund.
  I understand and accept the conditions for registration / withdrawal as outlined in the Westminster Conservatory 2014 summer camp brochure. 
  Yes

* Check the appropriate boxes to indicate the payment amount you are including with your regisrtation form: $100 deposit for each week of camp (Note: this option is available only if regeristing by 6/1)
Payment in full for one week of Piano Camp ($385 by 5/15 or $410 after 5/15)
Payment in full for two weeks of Piano Camp ($730 by 5/15 or $790 after 5/15)
Payment in full for three weeks of Piano Camp ($1050 by 5/15 or $1065 after 5/15)
Payment in full for Summer Orchestra or Summer Band Week ($330 by 5/15 or $350 after 5/15)
Payment in full for Flute Day Camp ($550 by 5/15 or $575 after 5/15)
Payment in full for Flute Residential Camp ($850 by 5/15 or $875 after 5/15)
Payment in full for Westminster Chamber Music Camp ($495 by 5/15 or $525 after 5/15)
Payment in full for Chamber Ensemble Camp ($495 by 5/15 or $520 after 5/15)
Payment in full for Jazz Starters Camp or Jazz Combo Boot Camp ($370 by 5/15 or $395 after 5/15)


I am regeristing less than one week prior to the start of camp and am including the $50 late fee:
Yes
* Total Payment Amount :
Daytime Phone (w/area code):   ()
 * Payment Information:  We accept Visa, MasterCard, Discover & American Express.
Card Type :
Credit Card Number:
Expiration Date (MMYYYY):
Security Code :
Name as it appears on card:
 * Is Credit Card Billing Address the same as Student Home Address listed above? Yes     No     (If "No", please specify below.)
Billing Address 1:
Billing Address 2:
City:
State:
Province/Region: (If not from US)
Zip/Postal Code:
Country:
Form Submission


Click Submit to send this form to Rider University. An acknowledgement screen will then appear.