Music Camp Registration

Music Camp Registration:

Please fill out all information completely

Camp Dates:

August 9 - 13, 2010

Camp Fees:

$35.00 per child

Child's First Name:
Child's Last Name:
Home Phone:
Cell Phone:
Email Address:
Child's Gender:	Male Female
Child's Date Of Birth:
Last School Grade Completed:
Street Address:
City:
State:
Zip Code:
Parent/Guardian First Name:
Parent/Guardian Last Name:
Emergency Contact (1) Name:
Emergency Contact (1) Phone:
Emergency Contact (2) Name:
Emergency Contact (2) Phone:
Any Additional Information:
Does this child have any disabilities, handicaps, or present injuries or limitations, allergies, hemophilia, heart conditions, history of respiratory illness, or any other significant medical condition?	Yes No
If above answer is yes, please explain:

Please list the instrument your child plans to use (Instrument Track only)
Child's Shirt Size:

PRICES:

$35.00 per week

Ages:

Completed 1st through 7th Grade

Camp Times:

8:30 am - 9:00 am: Drop Off/Registration

9:00 am - 12:00 pm: Camp Activity

12:00 pm - 12:30 pm: Pick Up

Please drop off registration fee at the church office Monday through Friday, between 9:00 am and 5:00 p.m