Summer Safari Fun RegistrationPlease enable JavaScript in your browser to complete this form.Which session would you like to register for? *Session One: IS FULLSession Two: July 29th-August 1st and August 5th-8th, 6:00-6:45 p.mYour Name *FirstLastEmail *Phone/Text *Preferred Method of Communication *EmailPhoneTextIn the event of an emergency during class, who should I call if you are not available? *FirstLastPhone *Relation *Child's Name *Prefers to be called...Child's Gender *MaleFemaleAge *Birthdate *Food allergies? If yes, list below... *How did you hear about this summer camp? *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. *YesNoWebsiteSubmit Registration Information
