Westminster Conservatory 2014 Early Childhood 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 camp for which you are registering: Beach Beats (Ages 2-3)
Musical Jamboree (Ages 4 - Grade 1)
Rainbows, Rhythms and Ringing (Grades 2-4)
* Check off all the weeks for which you are registering: (NOTE: Weekly theme is the same for all camps with the exception of August 4 - 8) Music of the Continents (July 14-18) (No Beach Beats this week)
A Day at the Museum (July 21-25)
Nature,You, and Music, Too! (July 28 - August 1)
Across the USA (Beach Beats Only) (August 4-8)
East Coast Express (Musical Jamboree and Rainbows, Rhythms, and Ringing only) (August 4-8)
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 State is "Other")
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 $35 per session for Beach Beats and $75 per session for Musical Jamboree and Rainbows, Rhythms and Ringing 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

* Select the appropriate option to indicate the amount you are including with your registration form: Non-refundable deposit of $35 per week for Beach Beats (NOTE: This option is available only if registering by 6/1))
Payment in full for one week of Beach Beats ($125 if registering by 5/15 or $140 after 5/15)
Payment in full for two weeks of Beach Beats ($210 if registering by 5/15 or $230 after 5/15)
Payment in full for three weeks of Beach Beats ($285 if registering by 5/15 or $300 after 5/15)
Non-refundable deposit of $75 per week for Musical Jamboree or Rainbows, Rhythms, and Ringing (NOTE: This option is available only if registering by 5/15)
Payment in full for one week of Musical Jamboree or Rainbows, Rhythms, and Ringing ($230 if registering by 5/15 or $245 after 5/15)
Payment in full for two weeks of Musical Jamboree or Rainbows, Rhythms, and Ringing ($410 if registering by 5/15 or $440after 5/15)
Payment in full for three weeks of Musical Jamboree or Rainbows, Rhythms, and Ringing ($585 if registering by 5/15 or $630 after 5/15)
Payment in full for four weeks of Musical Jamboree or Rainbows, Rhythms, and Ringing ($750 if registering by 5/15 or $810 after 5/15)
 
 * 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 Billing Address listed above? Yes     No     (If "No", please specify below.)
Billing Address 1:
Billing Address 2:
City:
State:
Province/Region: (If State is "Other")
Zip/Postal Code:
Country:
Form Submission


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