Camper Information

Tell us about your musician. We will ask for information about you and collect payment on the subsequent pages.

Camper First Name

Address

City

Zip

Camper Last Name

Address (Line 2)

State

Home Phone

Grade

Select the grade your camper will be entering in the fall.

Instrument

T-Shirt Size

Youth Small

Youth Medium

Youth Large

Adult Extra Small

Adult Small

Adult Medium

Parental/Guardian Information

Full Name of Parent or Guardian

Parent or Guardian E-Mail Address

Parent or Guardian Phone Number

Full Name of Parent or Guardian

Optional Secondary Parent or Guardian

Parent or Guardian E-Mail Address

Optional Secondary Parent or Guardian

Parent or Guardian Phone Number

Optional Secondary Parent or Guardian

Emergency Contact Information

In the event of an emergency, we will contact the parents or guardians listed above. In the event that such parent or guardian is unavailable, please provide an additional emergency contact person.

Full Name of Emergency Contact

Relationship to Student

Emergency Contact Phone

Emergency Camper Information

Does your child have any specific physical/health problems?

Yes

No

Describe any specific physical/health problems:

List any allergies your child may have:

Be very specific when listing.

My child will be bringing an epi-pen for emergency purposes.

Yes

No

Medical Insurance Company

Group Number

Contract Number

Additional Information

YES, we will be at the Concert on Friday, August 9th , 2019 @ 7:00 PM

NO, we will not be at the Concert on Friday, August 9th , 2019 @ 7:00 PM (please try and make every effort for your child to be at the Friday night concert. It is the greatest part of camp and sense of accomplishment!)

YES, I am able to help set-up for the Concert on the morning of August 9th (many hands make light work)

YES, we can bring the following for the Concert Afterglow (you will get a reminder) :

Last name starts with A-M: BRING A GOODIE (no nuts please of any kind)

Last name starts with N-Z: BRING A 2 LITER DRINK

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Camper Information