Westminster Conservatory 2014 Try-It-Out Summer Camp
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 
you are registering:
Try-It-Out (morning) (Grades 1-3) (July 21 - August 1)
Try-It-Out (afternoon) (Grades 1-3) (July 21 - August 1)
Try-It-Out (full day) (Grades 1-3) (July 21 - August 1)

* Student should choose one instrument to try out : Keyboard
Cello
Violin
 
Refer a Friend Program
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
 
 * Select the appropriate option to indicate the
amount you are including with your registration form:
Non-refundable deposit of $100 (Note: this option is available only if registering by 6/1)
Payment in full for 1/2 day if registering by 5/15 ($450)
Payment in full for 1/2 day if registering after 5/15 ($475)
Payment in full for full day if registering by 5/15 ($745)
Payment in full for full day if registering after 5/15 ($775)
 
I am registering 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 Billing 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.