Please fill out all the fields on this form and attach your registration form.

Date: *

Student Name: * Student Age: * Piano Grade: *

Requested Group: *

A B C D E

Address: * City * Province: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Phone Number: * email: * Teacher's Name: * Teacher's Email: * Parent's Name: * Parent's Email: * Please list any special dietary needs or allergies. I would like to volunteer to assist with student events and activities during Summer Sizzle Keyboard Kamp.

Registration Package *

Student - Tuesday July 11/ Wednesday July 12, 2023 ($315.00 CAD) ONE Parent Registration ($120.00 CAD)

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