Summer Music Institute

PERSONAL INFORMATION

All items with an asterisk (*) are required

Student's First Name*

Student's Last Name*

Student Email*

Student's Birthdate*

Text important updates and reminders to me (recommended)

Yes

No

EDUCATIONAL BACKGROUND

What school do you attend?*

In the fall what grade will you be in:

Have you previously attended the Buffalo State University Summer Music Institute?

Yes

No

How did you hear about the Buffalo State University Summer Music Institute?*

Music Teacher's Name*

Please list any private teachers you have studied with (please enter "none" if not applicable)*

PARENT INFORMATION

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Phone*

Parent/Guardian Email*

Photo release for publicity purposes – I understand that my child’s image may be used in photographs or videos for promotional purposes.

Yes

No

MUSIC BACKGROUND

Please specify your primary instrument*

Are you currently or have you taken private lessons on your primary instrument?*

Yes

No

PAYMENT INFORMATION

Summer Camp Payment Information

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Admissions