Register for Summer Music Camp!Please enable JavaScript in your browser to complete this form.Student's Name *FirstLastBirthdate *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, either photo or video, to be used solely for the purposes of Mindy Rawlinson Piano School's promotional material and publications. *YesNoComment or MessageCommentSubmit registration
