Registration Form for Summer Jazz Camp

July 22nd - July 26th 2024

First Name:

Last Name:

Address #1:

Address #2:


State: Zip:


Grade, Fall '24

Yrs Experience:

Improv. Experience:

Private Instructor:

School Name:

Adult T-Shirt Size (Check one):

Adult Small Adult Medium Adult Large Adult X-Large
Adult XX-Large

If interested in being a Counselor: (please check this box) Counselor

Prerequisites: Individual should be a college level student displaying a high level of accomplishment on his/her instrument (s) and the ability to assist others with their music and/or technical aspects of that instrument, in a professional manner.)


Parents name:

Home Phone:

Work Phone:

Email Address:

Fill out online and print out this form to register.
Please sign the form, include your check payable to "Tony Pietricola ", and mail to:

Tony Pietricola
Summer Jazz Camp
6 Old Town Lane
Grand Isle, VT 05458

Don't forget the T-Shirt Size. The shirt comes with the fee and we use it as part of the uniform for the concert.
Morning Session, $185.00
(Min. $50.00 Deposit, anytime before July 1.)

Full Day Session
(High School only),$285.00
(Min. $50.00 Deposit, anytime before July 1.)



Afternoon Session only
(High School only),$125.00
(Due anytime before July 1.)



I understand my $50.00 deposit is refundable in the event the camp has to be canceled. I also understand participants are strongly advised to be fully protected from Covid including all vaccinations and appropriate boosters and to wear masks whenever it is apporpriate.

Please sign in box
at right after printing:

Special Needs?
Any medication?