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RMAOA 2011 Summer Camp

To hold a place in RMAOA’s summer camps, please return a separate form for each child. A $100 non-refundable deposit is required to hold your child’s place and is included in the tuition. Please include $295 tuition per camper per session. Tuition fees of $295 will include Materials, Extended Hours, and Hot Lunches . Application will not be accepted without tuition. Space is limited, so register early. For questions or more information, call Elza Ritter at (703) 901-3614 or email her at ElzaRitter@gmail.com. We also speak Russian! To contact a Russian speaking employee please contact (571) 243-5083.

Child's Last Name: 
 

Child's First Name/Preferred Nickname:
 


Birth date:
 

School:
 

Grade Entering Fall 2010:
 

Mother/Guardian's Name:
 

Father/Guardian's Name:
 

Address:
 

City:
 

State:
 

Zip:
 

Home Phone:
 

Mother Work Phone:
 

Father Work Phone:
 

NOTE: We will be sending all communication (confirmations, parent handbooks, health forms, etc.) via E-MAIL, so please provide valid primary and secondary e-mail addresses.

Mother/Guardian e-mail:   Father e-mail:  


Study Experience:

Number of Years Study:

Number of Months Study:

 

Instrument student is studying:

Experience:
 
 

SESSION — choose the session you want to attend;




Time/Tuition(check all that apply):








Tuition fees of $295 will include Materials, Extended Hours, and Hot Lunches.


Check all that apply:

Current RMAOA Student
New to RMAOA

Sibling also applying: 
Enter Sibling Names

Camper's T-Shirt Size:


Pre-order a Camp Memory DVD
Please indicate number of copies ($25 a copy):  

How did you hear about the RMAOA Summer Piano Camp?

Payment Information
Credit Card or Paypal.

Pay by check

Please send a check to
RMAOA P.O. BOX 230715, Centreville va 20120
Made out to RMAOA

 

The person submitting this form understands and agrees to the RMAOA Summer Piano Camp Policies and accepts complete responsibility for the charges and fees that may be incurred.


By checking this box, I consent to and authorize the use and reproduction by the RMAOA or anyone authorized by the RMAOA, of any or all photographs that may be taken of the student registered on this form without further compensation to that student or his/her parents/guardians. 


 

 

 

 

14768 Basingstoke Loop, Centerville, VA 20120 | Phone: 703-901-3614 | Email: ElzaRitter@gmail.com

RMAOA 2011 All right reserved.

Instrument Lessons