MoonSchool Registration

Register here for MoonSchool's 2013 Summer Conservatories: MoonLight KIDS! and MoonLight JR!

Families get a $200 discount for siblings enrolled after the first student!

Refer a friend and get a 10% discount!

MasterCard, Visa, American Express, and Discovery are welcome.

Please make checks payable to "42nd Street Moon."
Note, tuition must be paid in full by June 15, 2013.

You can also download and print this form here: MoonSchool Registration Form for Summer 2013.

For questions about student placement, class availability or other school matters, please contact Education Director Dyan McBride or call 415-255-8205 x 103.

All Students Please Complete

First Name: *

Last Name: *

Address 1: *

Address 2:

Class: * MoonLight KIDS! (Ages 7-12)MoonLight JR! (Ages 13-17)

City: *

State: *

Zip: *

E-mail: *

Home Phone: *

Cell Phone:

Youth Students

Gender:

M

F

Age:

Birthdate:

Grade:

School:

Family E-mail:

Parent/Guardian 1:

Phone:

Parent/Guardian 2:

Phone:

Adult/Parent/Guardian Signature:

Photo Release Consent:

By typing my name in the space above, I hereby grant permission for my child to appear in photographs that may be published in hard copy publications (e.g., newsletters, brochures, newspapers), and/or on our web site. The copyright for all photographs will be held by 42nd Street Moon. This copyright includes any and all rights to include the picture in present and future publications of the company, in any format or media. Names are not used with photos.

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Enter the characters shown in the image.