Register

Registration Form for SSAC 2024

* Indicates required field

Student Name *

First

Last

Age *

Choose level *

Level 1 - Beginner (1-3 years experience) Level 2/3 - Intermediate-Advanced (3-7+ years experience) Unsure

Choose instrument *

Parent name *

Parent email *

Best contact phone number *

Select One *

Quick method of sending you information in case of schedule change, sick child, or emergency. Check all that apply. *

Email Text Phone Call Facebook message

What city do you live in? *

Please give more information on your child's experience with their instrument. Include school or community programs as well as any private instruction they may have had. *

List any allergies or health issues that we need to know about before serving snacks to your child *

Emergency contact name (other parent, family member or close friend) *

Emergency contact Phone Number *

Comment - Please list anything else you feel it would be good for our staff to know before working with your child. *

T-shirt Size *

Payment preference *

Hand deliver check or cash first day of camp Venmo - www.venmo.com/Carrie-Young-22

Enter PROMO code *

Submit

Park Day Consent & Media release

* Indicates required field

Parent/Guardian Name *

First

Last

Student Name *

First

Last

Email *

Choose all that apply. All options below include going from Family Lyceum to Central Park in Clearfield on July 17th 2024 *

I give my permission for my child to walk to Central Park with the group on July 27th, 2023 I am willing and able to come that day to volunteer to help with games, lunch, etc. My child has food allergies (please comment below) My child will not be attending the park activity

Comments or Preferences *

Media Release

I give my permission for my child to be photographed while at SSAC and I understand that such photos may be used for promotional purposes only. *

Yes No Yes, on the condition that...(please note condition in comment below)

Comment *

Type your name in the box below. This counts as your signature. *

You MUST click the SUBMIT button below, or your response will not be recorded. THANK YOU!

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