Summer Music Camp Registration

Child's Name*
First Last
Grade Child Will Be Entering*
Child's Shirt Size*
Parent Name:*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone Number
Cell Number*
Email*
Emergancy Contact Name:*
First Last
Emergancy Contact Number:*
All Known Allergies (food, bee stings, medications, etc), Medical Info, Food Needs, Concerns:
How did you hear about this camp?*
*
- As parent/guardian of the aboved-named minor child, I give Ormond Beach Presbyterian Church permission to video or photograph my child for marketing, decorative or promotional use.
*
- I acknowledge and consent that this electronic signature shall have the full force and affect of a hard copy and shall be given the same viability under the law as such.
Signature*
First Last
Date*
Date Format: MM slash DD slash YYYY