Class size is limited. Registrations will be accepted by e-registration or by mail or in person beginning Friday, December 9, 2011 on a first-come, first-served basis.

(Checks only.) Please make your checks for $110 payable to USC School of Music - CMDC and write your child's name on your check.

To enroll, print and return this registration form with your check to USC School of Music - CMDC, 813 Assembly, University of South Carolina, Columbia, SC 29208.

For more information please contact Dr. Valerio at 777-5382 or email: wvalerio@mozart.sc.edu.

SPRING 2012 classes begin on Wednesday, January 18 and end on Saturday, April 14.

Your registration will be confirmed e-mail by Friday, January 13, 2012, if your registration has been received by that date.

Child's Name (first and last): _________________________________

Child's Age: _______Sex: ____ Date of Birth: _____/____/_____

Parent(s)/Guardian(s):______________________________________________

Phone Number(s):_________________________________________________  

Email:__________________________________________________________

Address:________________________________________________________

City:______________________________,SC  Zip:______________________

Please circle your first choice for class day and time. (Assume you will be placed in your first choice unless you hear otherwise.)

Please circle your second choice for class day & time. (Because classes fill quickly, this selection should be an acceptable alternative if your first choice is unavailable.)

Please Read & Sign - I understand that each class will be video-recorded for the purpose of music development research by Dr. Valerio and her graduate students and for the purpose of teacher training sessions at conferences and seminars worldwide. I also understand that my child's identity and the identity of the caregiver(s) who accompany my child to class will be protected. 

Parent Signature:_______________________________Date:___________________ 

Please circle how you found us!

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