Southampton Summer Music - July 25 - 29, 2016
Home Coming Events
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Note: Online payment coming soon


First Name* :

Last Name* :

Name of Parent/Legal Guardian (If Under 18):

Parent/Legal Guardian Phone No. (If Under 18) :


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Age (as of December 31, 2017)* :


Address - Line 2

City / Town*

Postal Code/ Zip Code*


I will be paying my registration fees by* :

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Please Note
: PayPal will accept the following credit cards: Visa, MasterCard, American Express, Discover, JCB, Diner's Club and EnRoute

You do NOT require a PayPal account to pay with your credit card.

Name on Credit Card/PayPal or Cheque that will be used to pay registration fees* :

Emergency Local Contact - Name*

Emergency Local Contact - Address*

Emergency Local Contact - Phone Number*

PHOTO RELEASE: Permission to use registrant photos in printed material * :

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PHOTO RELEASE: Permission to use registrant photos on Summer Music website, social media * :

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Grade completed in June 2017( if under 18):

For Instrumental Programs - Instrument:

Years Played:

Years of private instruction:

Program: *


Tots & Tunes Mornings (4-5 yrs old) - $135.00

Musical Beginnings (6-8 yrs old) CLASS FULL - wait list only. Please choose Cheque as payment & we will contact you if an opening becomes available. - $250.00

Instrumental Beginnings (8-11 yrs old) - $250.00

Choral (9-11 yrs) - $250.00

Choral (12 yrs & up) - $250.00

Instrumental - $250.00

Guitar (9 yrs & up) - $250.00

Jazz (Advanced Students) - $300.00

Camper T-Shirt:*

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