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ROCK BAND CAMP REGISTRATION
Camper's Information
*
Indicates required field
Child's Name
*
First
Last
Child's Age
*
Child's Gender
*
Select One
Male
Female
Has child had prior musical experience singing or playing an instrument?
*
Select One
No
Yes
If "Yes", vocal, drums, guitar, bass, or keyboard?
*
How long?
*
Does the child have any special needs?
*
Select One
No
Yes
If "Yes", please explain:
*
The Camp Director will contact you to discuss and confirm that we are able and equipped to handle your child's special needs.
Does your child have any known allergies?
*
Select One
No
Yes
If "Yes", please specify:
*
Parent/Guardian Information
Parent/Guardian Name
*
First
Last
Parent/Guardian Name - 2nd Contact
*
First
Last
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Email
*
Email - 2nd Contact
*
Phone Number
*
Alt. Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Is anybody else authorized to pick up your child?
*
Select One
No
Yes
If "Yes", please list the name(s) AND phone number(s) of those who are authorized:
*
Preferences
Please indicate which role your student would prefer in the rock band, with "1" being their first choice and "5" being their last choice.
*
Note: Listing preferences below does not mean that campers will have their first choice of instrument/vocal in the final showcase. However, campers will have the opportunity to gain exposure to more than one instrument throughout the week.
Vocal
*
1
2
3
4
5
Guitar
*
1
2
3
4
5
Bass
*
1
2
3
4
5
Drums
*
1
2
3
4
5
Keyboard
*
1
2
3
4
5
Will your child need extended day care? (Extended day care is available for early drop-off or late pick-up. $10 per half hour. Advanced notice is required [prior day for early drop-off, same day for late pick-up]).
*
Early Drop-Off
Late Pick-Up
Not Needed
How/where did you hear about our camp?
*
Submit
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