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Student Name *:

Student Email (optional):

Student Phone Number (optional):

Parent/Guardian Name *:

Parent/Guardian Email *:

Parent/Guardian Phone Number *:

Second Parent/Guardian Name (optional):

Second Parent/Guardian Email (optional):

Second Parent/Guardian Phone Number (optional):

Grade Level (curriculum designed for 4th grade and up):

School:

Instrument:
—Please choose an option—ViolinViolaCelloBass
Session:
—Please choose an option—Pop Music: June 13-14 ($99)Movie Music: July 18-19 ($99)Pop Music + Movie Music ($198)
How did you hear about us?
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I grant permission for the Orchestra Academy to use videos or photographs of my student for educational purposes or promotion of the Orchestra Academy without payment or renumeration to either the Participant or the Parent or Legal Guardian.
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