Camper's
Information |
| Campers Last Name: |
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| Campers First Name: |
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| Campers
Address: |
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| City: |
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| State: |
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| Zip: |
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Phone Number:
(please be sure this number is operational) |
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| Parent's
Cell Phone: |
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| Parent's
Email: |
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| Verify
Email: |
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| Campers
Age: |
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| Campers
Date of Birth : |
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| Campers
Gender: |
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| Grade You will enter NEXT School Year |
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Type
of Registration:
* Children must be 9
- 17 years old to sleep over.
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| Would
you be willing to make a monetary donation to camp beyond the
registration fee ? If so please enter the
amount. If not leave blank. |
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****
ABOUT INSTRUMENTS AND LESSONS ****
Please read carefully
The focus of camp 2019 will be on music and musicianship. Our
instructors are all over 18, and have or are working toward a degree in
music education. All instruments must be
provided by the camper. Drummers must purchase a basic drum pad and
sticks prior to camp. All campers are expected to play at
least at a beginner level and have taken either group or private lessons. Due to lack of interest guitar and strings will not be offered this year.
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Instrument: (primary instrument) If not listed, select other and note it in the comments
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| Level
of musicianship: |
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Emergency
Information |
| Emergency
Contact 1 Name: |
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| Emergency
Contact 1 Phone: |
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| Emergency
Contact 1 Relationship to Camper: |
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| Emergency
Contact 2 Name: |
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| Emergency
Contact 2 Phone: |
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| Emergency
Contact 2 Relationship to Camper : |
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| Emergency
Contact 3 Name: |
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| Emergency
Contact 3 Phone : |
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| Emergency
Contact 3 Relationship to Camper : |
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Medical
information that we should be aware of: ( Medical information will be seen by the camp nurse, counselors and director only)
If a child needs medication, we need to know the dosage and the times
to administer the medicine. All medication will be administered by
the camp nurse. The medication must be in the original container with the
instructions clearly written on the bottle. The bottle must have the
child's name printed on the label. Any medication must be given to the
registration person upon check-in.
Skip if none |
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Food
Allergies:
Skip if none |
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| Can
we administer Tylenol if necessary: |
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| Can
we administer IBUPROFEN if necessary: |
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| Can
we administer antacid if necessary: |
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| In
the event of a medical Emergency, and we can not reach you or your
contacts, do we have your permission to have your child transported to
the hospital : |
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| Camper's
Physician Name: |
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| Camper's
Physician Phone: |
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| Camper's
Parent (s) Name: |
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| Is
your child allowed to go in the dumk tank at camp : |
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Please
tell us anything else about your child that we may need to know:
ONCE YOU CLICK SUBMIT AN INVOICE WILL BE CREATED PLEASE PRINT THE INVOICE AND REMIT YOUR PAYMENT ASAP
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