Date of Inquiry 

Student Last Name 

 Student First Name   

 Instrument:

 Private Teacher's Name (if applicable) 

Present Grade  School 

 Street Address 

 City    Zip 

 Home Phone Number    Cell Phone (if applicable) 

 Parents’ Names (First and Last) 

 Business Phone (Dad)  Business Phone (Mom) 

 Family Email Address

 We are interested in summer camp: Yes   No

  Any Comments/Questions/Concerns?