Service & Payment Plan*

Rock Academy - August 3-7

Price

$100.00

Guardian First Name*

Guardian Last Name*

Guardian Email*

Guardian Phone Number*

Student First Name

Student Last Name

Student Date of Birth*

Student Address*

Allergies/Medical Conditions*

Other pertinent info

Emergency Contact Name & Phone Number(s) (in the event guardian cannot be reached)*

Interested in additional summer classes and camps? Select them here, and we'll take care of the registrations for you!

By checking the below box, I state that I have read, understood, and agree to the linked Terms & Policies.*

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Payment Information*

Payment amount:

$100.00

Total to pay:

$100.00