UDCMS - Children's Choir Registration Form

Children's Choir Registration Form

Please complete this form and mail to:
      University of Delaware
      Community Music School
      Amy E. du Pont Music Building
      Newark, DE 19716

(Make checks payable to the University of Delaware)


Date______________

Student's Name______________________________________________________

Address_____________________________________________________________

City_______________________________ State_________ Zip______________

Birthdate________________                         Age_______________

Grade_________ School_______________________________________________

Parent/Guardian Name________________________________________________

Home Phone___________________________________________

Work Phone___________________________________________

Email Address________________________________________

Full tuition and all fees are due upon registration after acceptance
by audition.


Tuition                           $ 350

Registration Fee                  $ __________
($25 if received after August 15)

TOTAL                             $ __________


Method of Payment (Circle One)

Check     Cash      Visa      MasterCard       Discover      Am Ex


I authorize the UD Department of Music to charge

account number: __________________________________________________

Expiration_______________

Total amount to be charged________________

Print Name as on Card_____________________________________________

Signature_________________________________________________________