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 Gypsy Productions   

  Summer Camp 2011

Student’s Name:_______________________________________________

Address:_____________________________________________________

Parent’s E-mail Address:_________________________________________

Phone numbers:________________________________________________

Mother’s Name:__________________Father’s Name:___________________

Food Allergies or Medical Problems:________________________________

Age_____ Birth date________Height_______ M/F____Tee Shirt Size______

Tuition

One Student----------------$750.            Siblings------------------------$700.                 

Early Bird Discount---------$700.            Siblings----------------------- $650.

Summer School students----$500.            Referral discount--------minus $100.

For Early Bird discount, FULL payment must be received by April 1^st .

Total Due                     $______

Amount Enclosed         $______  (a non-refundable deposit of $250. is required)

Balance Due                 $______  (Due by June 27th )

Parent Signature: ___________________________________Date:________

Please select a time slot for auditioning on Fri., June 24^th: 

9:00-10:30____10:30-12:00____12:00-1:30_____ (confirmation letter & details to follow)

Mail this form and check, payable to Gypsy Productions, to:

Mayme Paul / 5699 Kanan Rd. / # 187 / Agoura Hills, CA  91301       phone 818.384.9386