Summer Camp Registration

Summer Camp Registration

Please complete the form below to register your child for summer camp.
Student Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Emergency Contact Name (Must be different from parent/guardian above)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Camp Selection

Please make your camp selection and payment below.

Camps*

Rochester Summer Camps

Rock Band Camp (Lake Orion)

JULY 20-24 - 9am-4:30pm (before/aftercare available, please ask): *Note* This camp takes place off campus at 550 E. Silverbell Road, Lake Orion. Ages 6-12.

$499.00 Quantity

Pop Piano Camp (Rochester)

JULY 27-31 - 1-4:30 Daily (can be taken with Singer Songwriter for full day option). Ages 6-12.

$309.00 Quantity

Singer Songwriter Camp (Rochester)

JULY 27-31 - 9am-12:30 Daily (can be taken with Pop Piano for full day option). Ages 6-12.

$309.00 Quantity

Bluey Piano Camp (Rochester)

AUGUST 3-7 - 9-11:30am - Ages 3-6. *Students must be bathroom independent to enroll*

$219.00

Music Safari Camp (Rochester)

AUG. 10-14 - 9-11:30am Ages 3-6 *Students must be bathroom independent to enroll*

$219.00

Oxford Summer Camps

Music Safari Camp (Oxford)

AUG. 3-7 - 9-11:30am Ages 3-6 *Students must be bathroom independent to enroll*

$219.00

Pop Piano Camp (Oxford)

AUGUST 10-15 - 1-4:30pm - Ages 6-12 (can be taken with Singer Songwriter from 9-12:30 for full day camp)

$309.00 Quantity

Singer Songwriter Camp (Oxford)

AUGUST 10-15 - 9-12:30 - Ages 6-12 (can be taken with Pop Piano camp from 1-4:30pm)

$309.00 Quantity

Bluey Piano Camp (Oxford)

JULY 27-31 - 9-11:30am - Ages 3-6. *Students must be bathroom independent to enroll*

$219.00

Royal Oak Summer Camps

Singer Songwriter Camp (Royal Oak)

AUGUST 3-7 - 9-12:30 - Ages 6-12 (can be taken with Pop Piano camp from 1-4:30pm)

$309.00 Quantity

Music Safari Camp (Royal Oak)

JULY 27-31 - 9-11:30am - Ages 3-6 *Students must be bathroom independent to enroll*

$219.00

Pop Piano Camp (Royal Oak)

AUGUST 3-7 - 1-4:30 Daily (can be taken with Singer Songwriter for full day option). Ages 6-12.

$309.00 Quantity

Bluey Piano Camp (Royal Oak)

AUGUST 10-15 - 9-11:30am - Ages 3-6. *Students must be bathroom independent to enroll*

$219.00

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Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Student Information
YesNo
If yes, please explain:
YesNo
AnxietyADD/ADHDOCDAsthmaAutism spectrum support needsSeizure disorderOther
YesNo
Please list the names of those who have permission to pick your camper up from camp, and their relationship to your camper:*

YesNo
Signature

I certify that the information provided above is accurate to the best of my knowledge. I understand that participation involves inherent risks, and I agree to hold harmless Red Piano Music Studio, its staff, volunteers, and employees from liability for injuries that may occur. I also understand that no refunds will be issued within 10 days of the camp start date.
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Summer Camp Registration

Camp Selection

Student Information

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