NC Suzuki Camp Online Registration Form

School of Music
NC Suzuki Institute @ ECU: Registration Form

NORTH CAROLINA SUZUKI INSTITUTE REGISTRATION FORM
Student Institute, July 8 - 13, 2012
Teacher Development Courses, July 6 - 13, 2012
Pre-Twinkle Day Camp (9-12pm), July 7 and 8, 2012
Every Child Can!, July 5, 2012
Please fill out a separate form for each participant!

Enrollment is limited. Early application is encouraged.
QUESTIONS? Call 252-328-4281 or e-mail us at suzuki@ecu.edu.

PERSONAL INFORMATION

Last Name:

First Name:

Age:

Student's Gender:

Male

Female

Parent's Name:

Daytime Phone Number:

Evening Phone Number:

Street Address:

City:

State:

Use two letter abbreviation (example: NC for North Carolina)

Zip Code:

E-mail Address:

Parent attendance?:

Parent(s) will attend (type name in blank below)

Student is 13 or older

All students under the age of 13 must be accompanied by a parent or another adult who will assume responsibility for the participating child. Please choose the appropriate option

Designated adult:

If you checked "Parent(s) will attend" above, please include name of adult attending with child here.

CLASS PLACEMENT

Instrument:

violin

viola

cello

ECC

Newest Piece: Book Number:

Newest Piece: Title:

Please list your student’s placement accurately as of today’s date. Do not anticipate where the student will be working by July.

Teacher's Name:

Teacher's Phone Number:

Teacher's E-mail:

Student has previous chamber music experience?:

Yes

If Yes, please briefly list the repertoire learned or other details about the students experience in the space below.

Chamber Music Repertoire:

Fill this in only if you answered "Yes" above.

INSTITUTE FEES

Application Fee:

Application Fee ($50 before June 1)

(non-refundable, 1 fee per student)

Tuition (per student):

Student Institute ($325+reg)

Violin Unit 1: Teacher Development Course ($450+reg)

Violin Unit 3: Teacher Development Course ($400+reg)

Every Child Can! ($100-no reg fee required)

Pre-Twinkle Day Camp (9-12pm July 2 and 3 only $25+reg)

Special Classes:

Fiddling ($50)

Chamber Music ($50)

Advanced Repertoire ($50)

Please check the additional classes in which you wish to participate ($50 per class).

HOUSING

Unit 1: Teacher Development Housing:

Double room ($350 per person-includes meals)

Private room (1 adult) ($400-includes meal plan)

Lodging for 8 nights (July 6-13) Meal plans start with dinner July 6 and end with dinner July 13.

Student Institute/Unit 3 Housing:

Double room ($300 per person-includes meals)

Private room (1 adult) ($350-includes meal plan)

Lodging for 6 nights (July 8-13) Meal plans start with dinner July 8 and end with dinner July 13.

Family Roommates:

Please list all family members who wish to stay together.

Unaccompanied Minor Fee:

for 13-17 year olds staying in dorm w/out parent(s) ($100)

Roommate preference:

MEAL PLAN (if not staying in dorm)

Indicate quantity:

Adult Meal Plan $150 (age 10 and above)

Indicate quantity:

Child Meal Plan $115 (age 9 and younger)

PARKING

Parking Fee:

Parking Pass ($10)

One per family

MERCHANDISE

Complimentary T-Shirt for each Registrant:

Child

Adult

Small

Medium

Large

X-Large

Institute Tote Bag ($20):

Please indicate quantity

PAYMENT

Total to be paid:

In this box, place the total dollar ($) amount due based on your selections in this form (add up the registration fee, tuition, housing and meals, parking, and place that total in this box). Please print this form for your records BEFORE you click the "submit" button below. After pressing Submit below, you will get a message about where to send payment.