PC Piano Clinic Student Registration Form

THIS FORM MAY BE PHOTOCOPIED

Name ________________________ Age ___ Grade in School ___ Phone ___________

Address ______________________ City ____________ State ____ Zip _____________

E-mail __________________________________________ Years of piano study ______

Teacher ___________________________ E-Mail _______________________________

Name and Number of Parents Attending the Clinic _______________________________

Repertoire for Clinic
_______ I wish to perform in a Friday Master Class
_______ I wish to perform in the Saturday Master Class (recording enclosed)

Title of Work: _______________________________
Composer __________________________________ Timing ______

Please return this form and clinic fee (Student $40 or Student Auditor $30; Parents $15 per person).
Make checks payable to PC Piano Clinic. Postmark date is January 25, 2008).

My son/daughter has my permission to attend the PC Piano Clinic. In case of
emergency requiring medical attention, I hereby authorize the faculty to act according to their best judgment. I release the College from all liability for any injuries or illness incurred during the clinic. I agree to assume the costs of any medical treatment required.

_________________________________________________________
Parent's Signature

 

 

PC Piano Clinic Teacher/Auditor Registration Form
Please return this form and the $30 clinic fee. This form may be photocopied.

Name ________________________________________________________________

Address ___________________________ City __________ State _____ Zip _______

E-mail __________________________________ Phone _______________________