Summer Music Camp Registration

Student's Name*

First Last

Grade Student Will Be Entering in the Fall 2022*

Does the student play any musical instruments?*

If yes, please list which instruments and how long they have played.

Student's Shirt Size*

Parent Name:*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number

Cell Number*

Email*

Emergency Contact Name:*

First Last

Emergency 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 above-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*