Brigitte’s Artistic Camp
REGISTRATION: all students
Student’s first and last name: Date of birth:
Address (with postal code)
Will you need before and after care? Please add 15$ for the week
In case of emergency phone nu. :
If need be on a rainy day, do you allow your child to watch a movie at the end of the day?
STRINGS AND HARPS PROGRAMS (please fill in)
Instrument: Years of playing:
What pieces, scales and studies did you play this year:
Teacher’s name and phone no.
Your sight reading is (circle): Very good, good, just starting, not yet
Are you preparing an exam? If yes, what grade?
WHICH GROUP are you registering for (please add letter for strings):
Do you own your instrument?
Will you take private lessons (circle): yes, no /If yes, choose how many:
1×30 min. = $20 (strings) 30$ (harps) / 1×45 min.= $30 (strings) 45$ (harps)
2×30 min. = $40 (strings) 60$ (harps) / 2×45 min. = $60 (strings) 90$ (harps)
3×30 min. = $60 (strings) 90$ (harps) / 3×45 min. = $90 (strings) 135$ (harps)
4×30 min. = $80 (strings) 120$ (harps) / 4×45 min. = $120 (strings) 180$ (harps)
For more information or questions, don’t hesitate to call me at 776-1026 or e-mail me at email@example.com
Please return this form with your payment to: Brigitte Amyot, 284 Boul. Riel, Gatineau, J8Z 1A9 (registration: 35$ + camp 230$ = 265$) lessons: _ / before and after care: 20$ (Cheques post-dated to April 1st are accepted)
or by e-mail to firstname.lastname@example.org / e-transfers are accepted.