EmailMe Form - Registration Form for Pedals, Pipes and Pizza

Registration Form for Pedals, Pipes and Pizza

A free event sponsored by the Greater Hartford Chapter, American Guild of Organists

Monday, February 15, 2016 - 9:30 am to 2:00 pm

Pedals, Pipes and Pizza is a great opportunity for young musicians to learn about the pipe organ and try its wonderful sounds. Any interested young person between the ages of 8 and 17 is welcome to attend. We will meet at 9:30 am at First Church of Christ, Congregational, 2183 Main St., Glastonbury. The day includes a pizza lunch, and will conclude at 2:00 pm with pickup at St. James’ Episcopal Church, 2584 Main St., Glastonbury, CT.

Student's Name *
First Last
Age *
Years of piano study
Years of organ study
Other instruments
Guardian Information
Please enter parent or legal guardian information here
Name *
First Last
Home Phone
### - ### - ####
Emergency phone contact *
### - ### - ####
Parent's Email Address *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Music teacher
Known allergies
Permission
Please check the box below to indicate that you give permission for your child to participate in the Greater Hartford Chapter of the American Guild of Organists “Pedals, Pipes and Pizza” program on February 15, 2016 and that you understand that your child may be included in photographs taken during the program. These photos might be used on the Chapter website, its newsletter or in the AGO magazine. We will not refer to your child’s name without your permission nor use the pictures in any other manner.
*
I give permission for my child to participate in this Pedals, Pipes and Pizza event.

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