Please fill out the following form to register for Summer 2010.

A seperate form is required for each student.

Summer Registration Fee $25 per family

Choose 1 or more of the following instruction offered: * Piano Voice Guitar Drums Flute Clarinet Saxophone Trumpet Trombone Baritone Tuba French Horn

Choose 1 or more Form of Instruction. Please call regarding available class days/times. * Classes-$150.00, Summer Term=8 Classes(Classes meet for 30 minutes and are scheduled between 1:00pm and 5:30pm) Private Lessons-$250.00 Summer Term=8 Lessons (30 minute lesson times scheduled between 1:00pm and 5:30pm) Summer Camps-(9:00am-11:30am) Weekdays. See fee schedule below

Summer Camps: Guitar mini Camp.......Ages 8 & Up......................(June 10-11).........................$55 Guitar Camp................Ages 11& Up.....................(June 14-18)......................$135 Rock Band Camp.......Ages 8 & Up......................(June 21-25)......................$135 Piano Camp................Ages 8 & Up......................(July 5-9).............................$135 Rock Band Camp.......Ages 11& Up.....................(July 12-16)....................... $135 Guitar Camp................Ages 8 & Up......................(July 26-30)........................$135 Drum Camp.................Ages 9 & Up......................(Aug. 2-6)...........................$135

Payment Options: Choose One * Option 1 Pay semester fees in full at time of registration **Cash, check or credit card** Option 2 Pay the semester fees in monthly payments **CASH OR CHECK ONLY**

Cash, Check or Credit Cards Accepted. Monthly payments are due by the first day of each month. Monthly invoices will not be mailed out. **Registration is not complete until payment has been received.**

Date: *

Electronic Signature of Responsible Party: *

Student Name: *

Select one: * New to Manzi's Music Returning Student

Age if under 18:

Grade in school:

School Attending:

Does student have any special needs we should be aware of?: * No Yes

If yes, please explain:

Parent/Guardian:

Address: *

City: *

State: * - - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code: *

I have read and agree to the policies and agreements stated on Manzi's Music, Inc.’s Policy and Agreement Form found under the forms page on www.manzismusic.com. **Registration is not complete until payment has been received.** * YES

Phone Number: *

Cell Phone:

Email Address: *

Check if CHANGE OF ADDRESS since last registration

Please contact us if you have questions or would like more information|www.manzismusic.com|(863)709-1401

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