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Music Mania Registration

Music Mania! Registration Form 2014

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 being offered free of charge, sponsored by the Department of Music at Gordon College. Program takes place in Phillips Music Center.

1. Child's First Name:

2. Child's Last Name:

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

4. Gender:


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 1/1/2014?

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.
Please do not include my child in photographs.

18. Submitter's initials: