Music Mania Registration

Music Mania! Registration Form 2015

To register your child for Music Mania, please complete and submit the form below. If you would like to register multiple children, please complete one form for each child.

There is no fee for participation, the program is sponsored by the Department of Music at Gordon College as a learning opportunity for both your children, and the undergraduate music education majors who are preparing for their careers as teachers in classrooms across the country.

1. Child's First Name:

2. Child's Last Name:

3. Date of Birth (mm/dd/yyyy):

4. Gender:

Male
Female

5. Mailing Address:

6. City:

7. State:

8. ZIP:

9. Phone:

10. E-Mail:

11. Parent/Guardian Name:

12. Please list an emergency number and contact name for the days of attendance:

13. Please list any allergies or medical conditions:

14. What school does the student attend?

15. What grade is the student in currently as of 1/1/2015?

16. Is the student involved in any other musical activities? (Private lessons, choir, community theater, dance etc.)

17. NOTE: Publicity photographs will be taken during Music Mania.

Yes, I understand that photographs will be taken and I give my consent for Gordon College to use these photographs for promotional purposes with the understanding that no names will be used which would identify the students.
Yes, I understand that photographs will be taken and I DO NOT give my consent for Gordon College to use the photographs of my child for promotional purposes.

18. Submitter's initials: