Summer Ukulele Camp 2023 Parent/Guardian Name * First Last * Last Email Address * Phone Number * Student Information Student's Name * First Last * Last Birthdate * Any Allergies * Yes No Please list all allergies * * Summer Ukulele Camp June 28-29 ($60) Christmas in July Ukulele Camp July 24-25 ($60) Both Camps ($100) plus1 Add Another Student minus1 Remove Student Emergency Contact Information Emergency Contact Name * First and Last Emergency Contact Phone Number * Permission Slip Please download the permission slip, fill it out, and bring it with you on the first day. DOWNLOAD HERE Photo and Video Release * Yes No Please ask on a case-by-case basis Does the instructor have permission to feature photos and/or videos of this student (never using full last name) on the studio bulletin board, website, Facebook page, and/or promotional items? Promo Code Total Cost This is the total cost for your camper and camp selections. Credit Card * Credit Card Credit Card Credit Card Month 123456789101112 Credit Card Year 20232024202520262027202820292030203120322033 Credit Card Billing Address * Billing Address Billing Address Billing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal If you are human, leave this field blank. Submit
