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MUSIC WORKSHOP REGISTER FORM

Student First Name:
Student Last Name:
Age:
Gender:
Parent or Legal Guardian Name:
Mailing Address:
City:
State:
Zipcode:
Home Phone:
Student Cell Phone:
Parent Cell Phone:
Parent Work Phone:
Emergency Phone:
Preferred Week:
Preferred Session:
Additional Sessions:
Preferred Instrument:
Other Instruments you can play:
Level of Musicianship:
Vocal Training:
List Bands and Artist you like:
List Songs interested to play:
List Medications:
Any medical problems or needs:
School Attending:
 

Music Workshop Rules:
  The main rule at Patrick Bolen’s Music Workshop is to have fun!  But, of course, anyone who is unruly, disrespectful, non-listening, or distracting will be asked to leave the workshop.
Agree To Rules:
 

Instrument Waiver:
  All instruments and equipment belong to Patrick Bolen, so if any musical equipment is damaged due to negligence by a student, the student will be financially responsible to pay for the repairs or, if necessary, replacement of equipment.
Agree To Instrument Waiver:
   

1st Step is to Submit this form.  

2nd Step is make payment to guarantee session and week.

  WAYS TO GUARANTEE PAID SESSION & WEEK

Patrick Bolen's Music Workshop
 $375.00 Per Session
One Session = 2.5hours per day for 5 Days in Patrick Bolen's Summer Music Camp
 
Send Money Order/Checks To:
Patrick Bolen
69 Strawberry Lane
Rolling Hills Estates, CA  90274
  
Call Us:
 1 (310) 541-0910 or Cell (310)872-4740

E-mail  bolenpro@bolenproductions.com

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