Denise Revo Music Studio
Summer Music Camps Registration Form 2011


To enroll call 816-554-2363 or mail this form along with your payment to:
Denise Revo Music Studio, 132 SE Battery Point, Lees Summit, MO 64063
Please make check payable to Denise Revo


Cost includes tuition and required high-quality materials (see Summer Camps)
  
Class Locations: 132 SE Battery Point (SE Battery)
 

SEE CONTACT US PAGE
FOR DIRECTIONS TO
EACH LOCATION
Peek-a-Boo, I Love You! (Newborn to 20 months)
 		 Cost: $65
July 12, 19, 26, August 2
July 12, 19, 26, August 2   		Tuesdays
 
Tuesdays		 9:20 - 10:00am (SE Battery)
 
6:00 - 6:40pm (SE Battery)
Silly All Over (1 1/2 to 4 years)
 		 Cost: $65
July 12, 19, 26, August 2
July 12, 19, 26, August 2		 Tuesdays
 
Tuesdays		 10:20 - 11:00am (SE Battery)
 
6:50 - 7:30pm (SE Battery)
 
Jazz Kitchen (4 to 6 years) Parents join last 10 minutes
 		 Cost: $65
July 11, 18, 25, August 1
July 14, 21, 28, August 4		 Mondays
 
Thursdays		 6:00 - 6:40am (SE Battery)
 
2:30 - 3:10pm (SE Battery)
Blast Off with Piano Camps! (6 to 9 years)
 		 Cost: $65
July 25 - 28
July 25 - 28
August 22 - 25		 Daily
 
Daily
 
Daily		 1:30 - 2:15pm (SE Battery)
 
6:15 - 7:00pm (SE Battery)
 
6:15 - 7:00pm (SE Battery)

Child's name:_____________________________  Age at beginning of session(Yr/mos) _____________
 
Parent's name:_________________________________________________________________
 
Address:_____________________________________________________________________
 
City: _________________________________  State: ______________ Zip: _____________
 
Home Phone: _________________________  Work/Cell Phone: __________________________
 
Email: _______________________________________________
 
New to program Previously Enrolled Update my Information
    
How did you hear about us? (Please circle one)
   
Print Ad Demo Phone Book Window Sign Car Magnet Other:___________________

Referred By: ___________________________________________

Is there anything you'd like me to know about your child that would help me best meet his/her needs?
 
____________________________________________________________________________________
 
____________________________________________________________________________________
 
Payment Options:

Prices listed above are for one child.  There is a reduced cost for siblings
in the same class or if you have materials from a previous enrollment.
(See Discounts and Special Offers on Schedule and Registration Page.)
Note: Payment is due in full regardless of the number of classes attended.

 
Option 1: Pay in full for the session
Option 2: Pay half at time of registration and the balance at the first day of class.
Option 3: Pay with PayPal
 
Check here if you are enrolling siblings in the same class or if you have materials from a previous enrollment.
 

Payment Option: 1     2     3  
Payment Method:  Check (Payable to Denise Revo)   Cash   PayPal
 
With this enrollment, I release any and all rights and claims for damages against Denise Revo Music Studio and it’s staff in the unlikely event of injury sustained by myself or my child(ren) during the course or as the result of this musical activity.
 
You have my permission to send me class related emails.
You have my permission to use photos or video taken of my child(ren) during class.



SIGNED:______________________________________________      DATE:______________________


Thank you for choosing Kindermusik!