| Student Name (first and last) : |
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| Register me for camp (pick one): * |
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| Full day or Half Day?: |
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| Age: |
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| Instrument: |
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| Any other instruments?: |
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| How long has student played?: |
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| Student Contact Email (if applicable): |
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| T-Shirt size (Child or Adult Small Medium Large, XL, XXL): |
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Parent/ Guardian Name
(first and last): |
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| Parent/ Guardian Contact Email: |
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| Parent/ Guardian Phone contact: |
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| Home Phone: |
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| Emergency Contact Name: |
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| Emergency Contact phone: |
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| Student Street address: |
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| City, State Zip: |
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| Please let us know if you or your child has any special needs, allergies, or if you have any concerns. Thank you! |
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By checking this box, I acknowledge that I have read and agree to the Hold Harmless Agreement.
I give my permission to have my child photographed for publicity purposes. |
Thank you!
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