Student Ensembles of Southern Maryland

Student's First and Last Name

Student's Age

Parent/Guardian's Name (if applicable)

Relationship to Student

Email Address

Phone Number

Emergency Contact Name

Emergency Contact Phone Number

Dismissal Options - Name all persons, including parents, who have permission to drop-off or pick-up your child:

Allergies, Medical Conditions or Special Concerns

Start Date of 1st Session

May 26
June 9
June 23
July 14
July 28

Start Date of 2nd Session

June 9
June 23
July 14
July 28

Classes take place on Thursdays and Saturdays, last 45 minutes and will be held between the hours of 11am and 5pm. Groups will be formed according to the student's age. You will be contacted by the director once the schedule has been set.

Name

Email

Phone

Message