Camper's
Information
Camper's Last Name:
Camper's First Name:
Camper's
Address:
City:
State:
Zip:
Phone Number:
(please be sure this
number is operational)
Parent's
Cell Phone:
Parent's
Email:
Verify
Email:
Campers
Age:
Campers
Date of Birth :
Campers
Gender:
Select
Male
Female
Grade
(09-10 school year):
Select
4
5
6
7
8
9
10
11
12
Type
of Registration:
* Children must be 9
- 17 years old to sleep over.
Please
Click here for an explanation of registration terms
Select One
A
Resident Week One-$225
B
Resident Week Two-$225
C
Both Resident-$450
D
Day Camper Week One-$175
E
Day Camper Week Two-$175
F
Day Camper Both-$250
G
Day Camper Week One w/activity-$200
H
Day Camper Week Two-w/activity-$200
I
Day Camper Both-w/activity-$400
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.
****
ABOUT INSTRUMENTS AND LESSONS
****
Please read carefully
The focus of camp will be on music and musicianship. Our
instructors currently have or are working toward a degree in
music education or music performance. Please note that we have a
limited number of string
instruments available for string players. All other 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. We
do not take very beginners with no previous experience on an
instrument! Vocalists
11-17 are the only exception. Please read the eligibility
document listed at the top of the page.
Instrument: (primary instrument)
** Guitars must be acoustic or non-amplified electric. Powered
headphones
are suggested. Use of amplifiers will be restricted to certain
times as
determined by Mark Reinhart.
Select
Violin
Viola
Cello
Bass - ONLY offered Week 2 (July
18th-23rd) for 2010
Guitar - Acoustic only
Trumpet
Trombone
Baritone/Tuba - ONLY offered Week 1 (July 11th - 16th) for 2010
Flute
Clarinet
French Horn - Only offered week 2, July 18th-23rd
Sax
Percussion
Vocal
Level
of musicianship:
Select
Beginner
Intermediate
Advanced
Emergency
Information
Emergency
Contact 1 Name:
Emergency
Contact 1 Phone:
Emergency
Contact 1 Relationship to Camper:
Emergency
Contact 2 Name:
Emergency
Contact 2 Phone:
Emergency
Contact 2 Relationship to Camper :
Emergency
Contact 3 Name:
Emergency
Contact 3 Phone :
Emergency
Contact 3 Relationship to Camper :
Medical
information that we should be aware of:
If a child needs medication, we need to know the dosage and the times
to administer the medicine. All medication will be administered by
adults. 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
Food
Allergies:
Skip if none
Can
we administer TYLENOL if necessary?
Select
Yes
No
Can
we administer IBUPROFEN if necessary?
Select
Yes
No
Can
we administer an ANTACID if necessary?
Select
Yes
No
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?
Camper's
Physician Name:
Camper's
Physician Phone:
Camper's
Parent(s) Name(s):
Is
your child allowed to go swimming with the group?
Select
Yes
No
Please
tell us anything else about your child that we may need to know:
If you are referring a
new camper, make note here
If you are registering
multiple children make note here