Blast Off With Piano! RegistrationPlease enable JavaScript in your browser to complete this form.Which session would you like to register for? *Session One IS FULLSession Two (July 22nd-26th, 2:00-2:50 p.m.) for 2nd-5th gradersSession Three (July 29th-August 2nd, 10:00-10:50 a.m.) for Kinder and 1st gradersSession Four IS FULLHow did you hear about these camps? *Student's Name *FirstLastPrefers to be called...Gender *MaleFemaleBirthdate *Does your student have any food allergies? *YesNoIf yes, what are they allergic to?Your Name *FirstLastEmail *Phone/Text *How do you prefer that I communicate with you? *Phone CallTextEmailIf there is an emergency during camp, who should I contact if I can't reach you? *Phone *Relationship to student *I hereby give permission for images of my child, captured during summer music camps through video, photo and digital camera, to be used solely for the purposes of Mindy Rawlinson Piano School's promotional material and publications. *YesNoComment or MessageNameSubmit registration
